Reduction and Resumption of Solid Organ Transplants in the COVID-19 Pandemic (preprint)

Background: Reduction of solid organ transplant (SOT) became notable while limited data are available regarding its resumption during the novel coronavirus disease 2019 (COVID-19) pandemic.Methods: Based on the SOT and COVID-19 diagnosis data collected from open-access official organizations, we studied the trend changes of SOT in the U.S.A. since the COVID-19 outbreak, and made the validation using the U.K. dataset. Trend curves were divided into virus-free, restrictive, and/or recovery phases. Kruskal-Wallis H test was performed to assess the differences among those phases with significance set at adjusted P < 0.05 (two-sided).Findings: In a 30-week (January 5 to August 1, 2020) observing period for the U.S.A. dataset, there was an obvious association between the trends of SOT and COVID-19 diagnosis (both overall and death cases) in the 10-week restrictive phase; significant reduction of overall SOTs per day were found in the restrictive phase (median 78.0, IQR 64.6-91.4) compared with the virus-free phase (median 115.0, IQR 97.5-132.5; P < 0.001); The most affected organ transplants were kidney (35.5% reduction) and lung (35.4% reduction), and the most affected U.S. region was Northeast (62.2% reduction). Resumption occurred with no significant difference found between the comparison of recovery (median 118.5, IQR 99.3-137.8) versus virus-free phases (P = 1.000) in overall SOTs per day, as well as those stratified by donor type (deceased and living), organ, and region. The SOT reduction and resumption were validated by the U.K. dataset.Interpretation: Using the U.S.A. and U.K. datasets, our study thoroughly presented the reduction and resumption patterns of SOT during the COVID-19 pandemic. It is essential that transplant units, based on the gained experience, make adequate preparations for any further possible COVID-19 attack.Funding Statement: This study received no external funding.Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: Exemptions of ethics approval, institutional review board, and informed consent were granted as data used in this study were publicly available.

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study (preprint)

Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males (62.4%). The median age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age, sepsis, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater age and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age , sepsis, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

Survey for Surgery status of a designated Hospital for COVID-19 management in Guangzhou

The definition and risks of Cytokine Release Syndrome-Like in 11 COVID-19-Infected Pneumonia critically ill patients: Disease Characteristics and Retrospective Analysis (preprint)

IMPORTANCE: COVID-19-infected pneumonia patients with severe immune abnormalities and risk of cytokine release syndrome. The definition, prevention, and treatment of COVID-19-infected pneumonia in critically ill patients with cytokine release syndrome symptoms is an important problem.