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Since March 2022, donors with detectable SARS-CoV-2 RNA have been accepted for extrapulmonary organ transplants in Brazil. In this report, we described 11 successful organ transplants (6 kidney, 5 liver) from 5 asymptomatic infected donors.
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Background and objectives Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. Methods Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). Results A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan–Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). Conclusion Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01172-1.
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BACKGROUND: Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM: To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS: This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS: The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION: The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patients died, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.
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COVID-19/mortality , Kidney Transplantation/mortality , Acute Kidney Injury , Adult , Aged , Brazil/epidemiology , COVID-19/complications , Cohort Studies , Comorbidity , Female , Hospital Mortality , Humans , Intensive Care Units , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , Male , Middle Aged , Renal Replacement Therapy , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Transplant Recipients/statistics & numerical dataABSTRACT
OBJECTIVE: To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. METHODS: This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. RESULTS: In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. CONCLUSION: The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.
Subject(s)
COVID-19 , Organ Transplantation/statistics & numerical data , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/statistics & numerical data , Brazil , HumansABSTRACT
Resumo Objetivo Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas. Resumen Objetivo Describir las donaciones y trasplantes de órganos en Ceará, Brasil, después de la declaración de la pandemia COVID-19. Métodos estudio descriptivo con datos de la Asociación Brasileña de Trasplantes de Órganos. Se comparó el número de donantes y trasplantes de abril a junio de 2020 con el mismo período de 2019 y el primer trimestre de 2020. Resultados El primer semestre de 2020, Ceará registró 72 donantes efectivos. De estos, 17 (23,6%) en el segundo trimestre. De 352 trasplantes realizados en el primer semestre de 2020, 37 (10.7%) fueron realizados en el segundo trimestre. En comparación al período de abril a junio de 2019, hubo reducción de 67,9% y 89,3% en el número de donantes y trasplantes, respectivamente, en el mismo período de 2020. Conclusión El número de donantes y trasplantes en Ceará mostró importante disminución en los tres meses siguientes al decreto pandémico COVID-19, especialmente las modalidades renal, cardíaca y córneas. Objective To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. Methods This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. Results In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.
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Resumo Objetivo Descrever as doações e os transplantes de órgãos no Ceará, Brasil, após a declaração da pandemia da COVID-19. Métodos Estudo descritivo, com dados da Associação Brasileira de Transplantes de Órgãos. O número de doadores e transplantes do período de abril a junho de 2020 foi comparado ao mesmo período de 2019 e ao primeiro trimestre de 2020. Resultados No primeiro semestre de 2020, o estado registrou 72 doadores efetivos. Destes, 17 (23,6%) no segundo trimestre. Dos 352 transplantes do primeiro semestre de 2020, 37 (10,7%) foram realizados no segundo trimestre. Em comparação ao período de abril a junho de 2019, houve redução de 67,9% e 89,3% no número de doadores e transplantes, respectivamente, no mesmo período de 2020. Conclusão Os números de doadores e transplantes do Ceará apresentaram importante declínio nos três meses seguintes ao decreto da pandemia da COVID-19, especialmente os das modalidades de rim, coração e córneas. Resumen Objetivo Describir las donaciones y trasplantes de órganos en Ceará, Brasil, después de la declaración de la pandemia COVID-19. Métodos estudio descriptivo con datos de la Asociación Brasileña de Trasplantes de Órganos. Se comparó el número de donantes y trasplantes de abril a junio de 2020 con el mismo período de 2019 y el primer trimestre de 2020. Resultados El primer semestre de 2020, Ceará registró 72 donantes efectivos. De estos, 17 (23,6%) en el segundo trimestre. De 352 trasplantes realizados en el primer semestre de 2020, 37 (10.7%) fueron realizados en el segundo trimestre. En comparación al período de abril a junio de 2019, hubo reducción de 67,9% y 89,3% en el número de donantes y trasplantes, respectivamente, en el mismo período de 2020. Conclusión El número de donantes y trasplantes en Ceará mostró importante disminución en los tres meses siguientes al decreto pandémico COVID-19, especialmente las modalidades renal, cardíaca y córneas. Objective To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. Methods This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. Results In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. Conclusion The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.