Encouraging outcomes of solid organ recipients with covid-19

Introduction: Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection. The specific features of coronavirus disease 2019 (COVID-19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Methods: Seven transplanted patients (two liver, three kidney, one double lung, one heart) admitted to the Ludwig-Maximilians-University Munich because of COVID-19 and tested positive for SARS-CoV-2 were included. The clinical course and the clinical findings were extracted from the medical record. Transplanted patients admitted to the ICU were compared to immunocompetent patients admitted to the ICU (n=19). Results: The two liver transplant patients and the heart transplant patient had an uncomplicated course and were discharged after 14, 18 and 12 days, respectively. Two kidney transplant recipients were intubated within 48 hours after admission. Weaning could be initiated in these patients after 16 and 19 days of mechanical ventilation, respectively. One kidney and the lung transplant recipients were required to be intubated after ten and 15 days, respectively. This kidney recipient was discharged in good health after 17 days. Thus, only the lung transplant recipient is on mechanical ventilation. Immunosuppression was adapted in five patients, but continued in all patients. Target trough levels were evaluated regularly and were within range during hospital stay. No graft loss or death was documented. Compared to non-transplanted patients the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL-6 and LDH blood values. Conclusion: This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS-CoV-2, their clinical course seems to be similar to immunocompetent patients.

Sars-cov-2 infection rates may be increased in dialysis patients on the transplant waiting list

Introduction: Chronic dialysis represents a state of immunocompromise. Unlike the general population, patients cannot observe strict isolation as they have to visit the dialysis unit three times per week and therefore potentially increase their risk of contracting an infection with SARS-CoV-2. This represents a special dilemma for patients awaiting renal transplantation. Active infection is considered a contraindication whereas renal transplantation may be considered for dialysis patients who have recovered. Methods: Referring dialysis physicians were surveyed to report non-transplantable and SARS-CoV-2 infected patients. The incidence of PCR-confirmed SARS-CoV-2 cases among dialysis patients on the kidney transplant waiting list was compared with a non-matched population in the referral area (Bavaria). Results: As of May 1st 2020, 42,489 individuals of the general population (0.33%) in Bavaria had been infected with SARS-CoV-2. At the same time, 4 out of 331 patients (1.3 %) on our waiting list contracted an infection with SARS-CoV-2. 2 were asymptomatic, one required inpatient treatment. None died due to COVID-19. 313 patients were without clinical signs of SARS-CoV-2 infection. Thereof 60 were also negative on PCR-testing due to infection in the respective centre. 5 patients had died during the pandemic due to non-COVID-19 related causes. For 18 patients no information on SARS-CoV-2 was available. Thus, patients on the renal transplant waiting list had a 3.9-fold higher incidence of SARS-CoV-2 infection (p=0.02). Conclusion: Although epidemiological statements based on this survey are deemed uncertain, the incidence of symptomatic SARS-CoV-2 infections in dialysis patients on the waiting list seems to be slightly higher. The absolute numbers are low, however, and the observed courses of disease are mild.

Organ donation and transplantation in times of the sars-cov-2 (Covid-19) pandemic: The eurotransplant perspective

Introduction: The SARS-CoV-2 pandemic has spread worldwide at an unprecedented speed, triggering drastic changes in routine patient care. This article describes the impact of the first pandemic wave on post-mortem organ donation and transplantation activities in the Eurotransplant (ET) region. Methods: The study period covers March and April 2020 and the corresponding reference period in 2019. The epidemiological COVID-19 data were retrieved from the John Hopkins University data resource center. Donor and transplant data were extracted from the ET database. Results: With the increase in COVID-19 cases, postmortem organ donation (-91) and total transplant activity (-272) decreased significantly in whole of ET, with significant regional differences. On top of the lower transplantation activity due to the lower organ donation rate, there was a deliberate decision by transplant physicians not to perform non-urgent transplants. Conclusion: Pandemic-related cuts in treatment capacity led to a dramatic decline in organ donation and transplantation. A corresponding increase in waiting list mortality is expected.