ABSTRACT
Purpose: To understand the outcomes and changes in disease severity of COVID-19 in Solid Organ Transplant (SOT) recipients over time in the context of therapeutic advances. Method(s): We performed a multicenter, prospective cohort study of all SOT recipients diagnosed with COVID-19, across 9 transplant programs in Canada, from March 2020-November 2021. Baseline characteristics, demographics, treatment and disease severity outcomes were collected. The primary outcome was need for supplemental oxygen. Factors associated with the primary outcome and changes in outcomes over time were analyzed. Pandemic time periods were divided into four time frames coinciding with 4 waves in North America. Result(s): We enrolled 509 SOT recipients with confirmed COVID-19 during the study period. The risk factors associated with oxygen requirement are outlined in Table 1. Severe disease and mortality were greatest in lung transplant recipients compared to other organ types (15/48 (31.3%) lung deaths vs 63/461(13.7%) nonlung organs, (p=0.001). There was no influence of 2-dose vaccination and 3 patients were infected after 3-dose vaccine. Disease with alpha or delta variant was not associated with increased oxygen requirement. In a subgroup analysis of participants requiring oxygen (n=190), remdesivir was associated with less death (p=0.035). Over the pandemic period (Figure 1), there were no significant changes in the proportion of patients requiring oxygen, ICU admission, ventilatory support or death. (Table Presented) Conclusion(s): COVID-19 is especially severe in lung transplant recipients and immunosuppression plays a significant role. The outcomes associated with COVID-19 in SOT have not appreciably changed over time despite the emergence of novel variants and changes in therapeutic regimens.
ABSTRACT
Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been associated with an increased mortality worldwide over the last year. Novel vaccines against SARS-CoV-2 offers new perspectives to control the virus. Major side effects of these vaccines, especially those affecting the kidney, appear to be uncommon. Although minimal change disease (MCD) has been reported three times following the Pfizer-BioNTech SARS-CoV-2 vaccine, no cases are described to our knowledge after the Oxford-AstraZeneca vaccine SARS-CoV-2 vaccine. Case Description: A 71-year-old man known for dyslipidemia and a serum creatinine of 0.7 mg/dl presented with nephrotic syndrome and acute kidney injury 13 days after receiving the first injection of the Oxford-AstraZeneca SARS-CoV-2 vaccine. On admission, urine analysis revealed 2321 mg of protein per mmol of creatinine and significant hematuria as well as granular casts. His serum albumin and creatinine were 2.8 g/dl and 10.6 mg/dl, respectively. Polymerase chain reaction for SARS-CoV-2 was negative. A workup to exclude auto-immune disease, active infection and neoplasm was negative. A kidney biopsy was performed 4 days after admission and 17 days after vaccination. It showed minimal change disease with acute tubular injury. Steroid therapy was initiated. Hemodialysis was stopped 38 days after the start of therapy. At dialysis cessation, serum creatinine was 1.4 mg/dl with a marked decreasing in spot microalbuminuria. Discussion: We suspect that this case of MCD might be related to the Oxford-AstraZeneca SARS-CoV-2 vaccine injection. To the best of our knowledge, this would be the first published case of MCD related to this vaccine. However, MCD has been described after other vaccines, including 3 cases after the Pfizer-BioNTech SARS-CoV-2 vaccine. The fact that MCD is now described with different types of SARS-CoV-2 vaccines argues on a potential mechanism not implying a direct effect of the vaccine itself, but a T cell process ignited by the vaccine that leads to podocyte injury. Since vaccination is the most promising way out of the current SARS-CoV-2 pandemic, millions of doses of vaccines will be administered around the world in a near future. Thus, nephrologists should be aware of this rare but reversible potential complication of COVID-19 vaccination.