ABSTRACT
BACKGROUND AND AIMS: Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases. METHOD: We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir. RESULTS: A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75-68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5-135.5) months, with median glomerular filtration at admission of 47.5 (42.25-63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10-18) days. CONCLUSION: KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.
ABSTRACT
BACKGROUND AND AIMS: The treatment of coronavirus disease (COVID-19) is based on the patient's clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in KT patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARSCoV- 2 aetiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID- 19 pneumonia and those with non-COVID-19 pneumonia over the same period. METHOD: Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n=42) and non-COVID-19 pneumonia (n=18) from March to November 2020. RESULTS: Both groups showed comparable demographics. The COVID-19 KT patients had fewer neutrophils (4,650 [2,925-9,498] vs. 9,100 [7,170-11,150],p=0.01) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non-COVID-19 pneumonia was associated with a higher d-dimer (962 [427-1,448] vs. 1,704 [868-2,481],p=0.09) and IL-6 (37 [23-10] vs 254 [53- 602],p=0.006) levels. The ferritin level was higher in the COVID-19 group (908 [496- 1,377] vs. 340 [264-785],p=0.008). CONCLUSION: COVID-19 pneumonia in KT recipients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be usefully to identify KT patients with COVID-19.More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.
ABSTRACT
The COVID-19 pandemic has forced the establishment of preventive measures against contagion during the performance of diagnostic and therapeutic tests in gastroenterology. Digestive tract motility tests involve an intermediate and elevated risk for the transmission of COVID-19 infection. Given their elective or non-urgent indication in the majority of cases, we recommend postponing those tests until significant control of the infection rate in each Latin American country has been achieved during the pandemic. When the health authorities allow the return to normality, and in the absence of an effective treatment for or preventive vaccine against COVID-19 infection, we recommend a strict protocol for classifying patients according to their infectious-contagious status through the appropriate use of tests for the detection of the virus and the immune response to it, and the following of protective measures by the healthcare personnel to prevent contagion during the performance of a gastrointestinal motility test.
Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Infection Control/standards , Neurology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Breath Tests , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Esophageal pH Monitoring/standards , Gastrointestinal Diseases/therapy , Gastrointestinal Motility , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Latin America , Manometry/standards , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Societies, MedicalABSTRACT
The COVID 19 pandemic has forced the establishment of measures to avoid contagion during diagnostic and therapeutic tests in gastroenterology. Gastrointestinal motility studies involve a high and intermediate risk of transmission of infection by this virus. Given its elective or non-urgent indication in most cases, we recommend deferring the performance of these tests until there is a significant control of the infection rate in each country, during the pandemic. When health authorities allow a return to normalcy and in the absence of effective treatment or a preventive vaccine for COVID 19 infection, we recommend a strict protocol to classify patients according to their infectious-contagious status through the appropriate use of tests to detect the virus and its immune response, as well as the use of protective measures to be followed by health personnel to avoid contagion during the performance of a gastrointestinal motility test. Resumen La pandemia por COVID 19 ha obligado a establecer medidas para evitar los contagios durante la realización de pruebas diagnósticas y terapéuticas en gastroenterología. Los estudios motores del tubo digestivo implican un riesgo elevado e intermedio de trasmisión de la infección por este virus. Dada su indicación electiva o no urgente en la mayoría de los casos, recomendamos diferir la realización de estas pruebas hasta que haya un control significativo de la tasa de infección en cada país, durante la pandemia. Cuando las autoridades sanitarias permitan el regreso a la normalidad y en ausencia de un tratamiento efectivo o una vacuna preventiva de la infección por COVID 19, recomendamos un protocolo estricto para clasificar a los pacientes de acuerdo a su estatus infecto-contagioso mediante el uso apropiado de pruebas para la detección del virus y su respuesta inmune, así como el uso de medidas de protección que deberá seguir el personal de la salud para evitar el contagio durante la realización de una prueba de motilidad gastrointestinal.