Subject(s)
COVID-19/epidemiology , Graft Rejection/drug therapy , Organ Transplantation , SARS-CoV-2 , Tacrolimus/pharmacokinetics , Transplant Recipients , Adult , Comorbidity , Female , Graft Rejection/epidemiology , Graft Rejection/metabolism , Humans , Immunosuppressive Agents/pharmacokinetics , Male , Middle Aged , PandemicsABSTRACT
BACKGROUND: The coronavirus disease (COVID-19) pandemic is stressing healthcare services to an unprecedented extent. There is anecdotal evidence of reduction in organ donation and transplantation activity across the world. METHODS: The weekly organ donation and liver transplant numbers over a 3-month period (Feb 17, 2020, till May 17, 2020) for the United States, United Kingdom, and India were compared with their previous year's activity. Liver transplant activity in 6 centers from these countries with varying local COVID-19 caseload was also compared. RESULTS: The COVID-19 pandemic has led to a significant contraction in organ donation and liver transplantation in all 3 countries. Peak reduction ranged from 25% in the United States to over 80% in the United Kingdom and India. The reduction was different for deceased donor and living donor liver transplantation and varied between centers within a country. There was early evidence of recovery of deceased donation in the United States and United Kingdom and resumption of living donor liver transplantation activity in India toward the end of the study period. A number of policy changes were undertaken at national and transplant center levels to ensure safe transplantation despite significant redirection of resources to combat the pandemic. CONCLUSIONS: There was a substantial reduction in organ donation and liver transplantation activity across the 3 countries with signs of recovery toward the end of the study period. Multiple factors including COVID-19 severity, stress on resources and influence of regulatory agencies and local factors are responsible for the reduction and recovery.
Subject(s)
Coronavirus Infections/epidemiology , Liver Transplantation/trends , Pneumonia, Viral/epidemiology , Tissue and Organ Procurement/trends , Betacoronavirus , COVID-19 , Humans , India , Living Donors , Pandemics , SARS-CoV-2 , United Kingdom , United StatesABSTRACT
Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.