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1.
American Journal of Transplantation ; 22(Supplement 3):768, 2022.
Article in English | EMBASE | ID: covidwho-2063440

ABSTRACT

Purpose: Short-term adaptive immune memory has been reported among immunocompetent (IC) and convalescent Solid Organ Transplant (SOT) individuals following SARS-CoV-2 infection as well as after active vaccination. However, quality and longevity of anti-viral immune memory comparisons between natural and active immunization has not been thoroughly assessed among SOT. Method(s): SARS-CoV-2-specific adaptive immune memory was assessed at different compartments (serological, memory B cells [mBC] and cytokine [Th1: IFN-gamma, IL-2, IFN-gamma/IL-2 and Th2: IL-21 and IL-5] producing T cells) by ELISA and FluoroSpotbased assays, respectively, in 41 convalescent patients with severe COVID-19 (22 SOT and 19 IC) and 39 vaccinated patients (19 SOT and 20 IC) with a mRNA-based vaccine) at different time-points post immunization (T1=21days after infection/1st dose;T2=3months after infection/2nd dose;T3=6months after infection/2nd dose). Additionally, a group of convalescent mild (19 SOT and 19 IC) and asymptomatic patients (9 SOT and 10 IC) were also evaluated at T3. Result(s): Overall, statistically significant higher immune responses in all immune compartments were observed in convalescent patients than among those after vaccination. After vaccination, low seropositivity rates (5,88%) were observed among SOT after 1st dose, whereas seroconversion was fully achieved in IC patients and SOT with severe COVID-19 (p<0.001). Similarly, while the presence of mBc after vaccination progressively increased over time, it was less pronounced and significantly delayed among SOT than convalescent patients in all time points (p<0.001 T1, T2 and T3). SARS-CoV-2-specific Th1 and Th2 frequencies were significantly higher among vaccinated IC patients than SOT, being these responses significantly lower than those observed in convalescent among SOTT and IC patients (p<0.001 T1, T2 and T3). At 6 months after vaccination, IgG titers, mBc frequencies and Th1/ Th2 T-cell responses after two-dose vaccination in SOT mimicked those observed in convalescent SOT with an asymptomatic/mild clinical COVID-19 infection. Conclusion(s): The type of immunization against SARS-CoV-2, either natural or active after vaccination, clearly differentiates the quality and length of adaptive immune memory, with a clear weaker immune response observed among SOT.

3.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S222-S223, 2022.
Article in English | EuropePMC | ID: covidwho-1781799

ABSTRACT

Introduction Heart tansplant (HT) recipients constitute a population at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Efficay and safety of SARS-CoV-2 vaccine in this population is still yet to be established. It has been described, immune thrombotic thrombocytopenia, myocarditis and Guillain-Barre syndrome in individuals who received the ChAdOx1 SARS-CoV-2 vaccine. There are very few cases of acute rejection after SARS-CoV-2 vaccination post HT patients. We will describe a several outcome of heart function vaccine-induced. Case Report A 46-year-old heart transplanted male since 2015, started with persistent cough 15 days after a dose of adenoviral vector-based vaccine against SARS-CoV-2. As he had increased troponin and new left ventricular dysfunction, he underwent an endomyocardial biopsy, collected an panel reactive antibodies (PRA) and started pulse dose metylprednisolone. He developed an ischemic electrocardiographic alteration with a ST elevation and the coronary angiography found a thrombosis in the anterior descending coronary artery with no success with percutaneous treatment. Endomyocardial biopsy found no acute rejection, and PRA showed de novo donor specific antibodies (DSA). Despite treatment for antibodie-mediated rejection with plasmapheresis, human immunoglobulin and rituximab, he had a cardiogenic shock, refractory to inotropic support and intra-aortic balloon pump, requiring peripheral VA ECMO. Regardless of initial hemodynamic response and partial recovery of biventricular function, patient could not stand weaning from ECMO and inotropes. After rejection therapy, PRA showed no antibodies and patient was included in HT list and had a retransplant after 16 days without complications. Summary To the best of our knowledge, this is the firts report of antibodie-mediated rejection in heart-transplant patient with thrombotic complication after ChAdOx1 SARS-CoV-2 vaccine. Although vaccination remains the main approach of preventing SARS-CoV-2 infeccion, transplant recipients were not included in clinical trials, so its safety remains unknown in this population. More studies are needed in order to increase knowledge about vaccine outcomes in these individuals.

4.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S328-S328, 2022.
Article in English | EuropePMC | ID: covidwho-1781798

ABSTRACT

Purpose A recent UNOS analysis comparing COVID-19 to pre-COVID-19 era found an increased waitlist inactivation, decreased waitlist addition, and decreased in numbers of heart transplant (HT). In Brazil, a pronounced negative effect on transplant was anticipated but has not been measured so far. Our objective was to evaluate the impact of COVID-19 pandemic on heart donation and HT. Methods We performed a descriptive analysis of data related to patients registered in HT waitlist and numbers of HT performed from March 2018 to August 2019 (pre-COVID era) and March 2020 to August 2021 (COVID era), by reviewing medical records and data from State Transplant System. Results A total of 221 patients were included in HT waitlist from 2018 to 2021. Approximately the same number of patients were listed in pre-COVID and COVID era (111 vs 110, respectively). Mean age of patients were 48.7 in the pre COVID and 48.9 years in the COVID era (p=0.91). The majority were listed as top priority criteria, 94 (85.5%) in COVID vs 100 (90.1%) in pre-COVID era, p=0.293, mostly due to mechanical circulatory assist devices ECMO and Centrimag (10.9% vs 18%), and intra-aortic balloon pump (41.8 % vs 39.6%) respectively, p=0.496. There was no difference in the survival of patients in waitlist (p = 0.226). Regarding number of HT, we observed highest absolute number of surgeries in the pre-COVID era (78 vs 66), with no statistical significance (p=0.109). There was no difference between the deaths after HT, 17 (15.3%) in pre-COVID and 9 (8.2%) in COVID era, p=0.249. During the peak of number of COVID-19 cases in Brazil (may-july 2020 and february-april 2021) we observe a reduction in overall heart transplant procedures an inclusion in waitlist (figure). Conclusion To the best of our knowledge, this is the first report of the impact of COVID - 19 on solid organ donation and HT. There were no differences between number of patients included in HT waitlist and outcomes after HT before and during COVID. However, there was a decrease in number of HT and inclusion in HT waitlist during the peak of COVID-19.

5.
Blood ; 136:37-40, 2020.
Article in English | EMBASE | ID: covidwho-1348289

ABSTRACT

Introduction:Recently there has been a renewal of therapeutic tools for the treatment of lymphoid neoplasms to increase the antitumor efficacy and reduce the toxicity generated by conventional chemotherapies, which adds to the intrinsic immunological dysfunction of the disease itself. To date, few data are published about infection risk of these new drugs, and the need for infectious prophylaxis is unknown. The aim of the study is to analyze the infectious complications in patients with LPD treated with monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab, nivolumab and pembrolizumab), BTK inhibitors (ibrutinib, acalabrutinib) and PI3K inhibitors (idelalisib). Methods: Multicenter retrospective study in patients with LPD treated with targeted therapies (single agents or combination) in 18 Hematology centers in Spain, from the time of their commercial availability to March 2020. Patients in clinical trials were excluded as well as patients with active infections at the beginning of treatment. Results:During the study period, 380 patients were included.Baseline characteristics of the entire cohort are shown in Table 1.Median follow-up was 17.3 months (range 0-103), the longest follow-up corresponding to CLL patients (24 months, range 0-98) and the shortest to LBCL (5 months, range 0-25). Median exposure to target drugs was 8 months (range 0-72).Ibrutinib was administered to 219 patients(1 FL, 147 CLL, 27 MCL, 10 DLBCL, 1 TL and 32 WM, 1 HL),Brentuximab to 49(31 HL, 14 TL and 4 DLBCL) andIdelalisibto 35 patients (16 affected by chronic lymphocytic leukemia - CLL, 15 FL and 1 DLBCL, 1 WM, 1MCL, 1HL).Obinutuzumabcombinations were used in 10 (6 CLL, 3 FL, 1 MCL) and 5 HL patients (of which 4/5 underwent previous BMT) receivedNivolumab. A total number of 237 infectious events occurred in 148/380 patients (38.9%), 39% of which were grade 3 and 54/148 (36.4%) experienced 2 or more infective episodes: of those 54, 21 (38%) had underwent 3 or more lines of therapy and 28 (51%) had hypogammaglobulinemia. Hospitalization was required in 59.2% events. A bacterial cause of infection was reported in 40% of cases, and viral in 16%, including 11/237 (4,6%) SARS-CoV-2 infection. Invasive fungal infection (IFI) occurred in 3.3% (8/237). Noteworthy, no case of PJP was identified. Lung was the most frequent site of infection in 24% of cases (57/237) while the upper respiratory tract was involved in 17% of events (41/237). Urinary tract infections were diagnosed in 10% (24/237). Other sites involved were skin and soft tissue 7%, gastrointestinal tract 5,4%, bloodstream infections 3% and catheter related infections 2,5%. Considering drugs individually, 86 patients that receivedIbrutinib(39.2 %)experienced a total of 137 infectious episodes: 30% bacterial, 19% viral, 5% fungal and 45% clinical and image-based infections;the 17(34.6%of those who received Brentuximab, experienced a total of 16 infectious episodes: 56% bacterial, 37.5% viral infections and one catheter-related sepsis. Of those who receivedIdelalisib,18 (51.4%)experienced a total of 28 episodes: 42% bacterial, 14% viral and 7% fungal. Four patients treated withObinutuzumabcombinations (40%) experienced one infection during treatment (25% bacterial and 75% viral). Only one patient treated withNivolumabexperienced more than three infections, he was also under corticosteroid treatment. Focusing on IFI (Table 2): 7/8 infections were identified in CLL patients, 6 out 7 being on ibrutinib treatment and 1/7 on Idelalisib.Aspergilluswas the fungus most frequently isolated. The targeted drug was discontinued temporarily in 4 patients and indefinitely in 3. Twenty three (6%) patients died due to infection in our series. Conclusions: 1. We identified 38.7% infections in our LPD patients treated with targeted drugs, with a median drug-exposure time of 8 months (range 0-72), with a non-negligible incidence of bacterial infections. 2. The highest rates of infection were found in patients treated with with Idelalisib and Ibrutinib (51.4% and 39.2% respectively). 3. IFI (3.3%) occurr d with low frequency, mostly in CLL patients during ibrutinib treatment, leading to its temporal discontinuation in most of the cases. 4. No case of PJP was identified in our cohort. 5. An analysis to determine risk factors for infection and the optimal monitoring and prophylaxis for these patients is ongoing. [Formula presented] Disclosures: Hernandez-Rivas:Janssen:Membership on an entity's Board of Directors or advisory committees;Abbvie:Membership on an entity's Board of Directors or advisory committees;Roche:Membership on an entity's Board of Directors or advisory committees;AstraZeneca:Membership on an entity's Board of Directors or advisory committees;Gilead:Membership on an entity's Board of Directors or advisory committees;Celgene/BMS:Membership on an entity's Board of Directors or advisory committees;Rovi:Membership on an entity's Board of Directors or advisory committees.Lopez-Guillermo:novartis:Consultancy;celgene:Consultancy, Research Funding;roche:Consultancy, Research Funding;gilead:Consultancy, Research Funding.

6.
Electronic Journal of General Medicine ; 18(4):2, 2021.
Article in English | Web of Science | ID: covidwho-1241375

ABSTRACT

Coronavirus disease 2019 (COVID-19) has caused more than 32 million cases and almost a million deaths. Recent reviews have evidenced the role of hypertension in prognosis, nevertheless, its association with immunosuppression in COVID-19 context has not been studied. It was performed a cross-sectional analysis of a large Mexican population with the infection (n=681 890). Prevalence of immunosuppression and hypertension was 1.10% and 19.50%, respectively. The adjusted model evidenced that hypertension was significantly associated with immunosuppression (odds ratio=1.18, 95% CI=1.11-1.25). Further research in pathways that justify the association between hypertension and immunosuppression in COVID-19 patients is recommended.

7.
Frontiers in Public Health ; 9:586670, 2021.
Article in English | MEDLINE | ID: covidwho-1210304

ABSTRACT

The COVID-19 pandemic has the potential to affect all individuals, however in a heterogeneous way. In this sense, identifying specificities of each location is essential to minimize the damage caused by the disease. Therefore, the aim of this research was to assess the vulnerability of 853 municipalities in the second most populous state in Brazil, Minas Gerais (MG), in order to direct public policies. An epidemiological study was carried out based on Multi-Criteria Decision Analysis (MCDA) using indicators with some relation to the process of illness and death caused by COVID-19. The indicators were selected by a literature search and categorized into: demographic, social, economic, health infrastructure, population at risk and epidemiological. The variables were collected in Brazilian government databases at the municipal level and evaluated according to MCDA, through the Program to Support Decision Making based on Indicators (PRADIN). Based on this approach, the study performed simulations by category of indicators and a general simulation that allowed to divide the municipalities into groups of 1-5, with 1 being the least vulnerable and 5 being the most vulnerable. The groupings of municipalities were exposed in their respective mesoregions of MG in a thematic map, using the software Tabwin 32. The results revealed that the mesoregion of Norte de Minas stands out with more than 40% of its municipalities belonging to group 5, according to economic, social and health infrastructure indicators. Similarly, the Jequitinhonha mesoregion exhibited almost 60% of the municipalities in this group for economic and health infrastructure indicators. For demographic and epidemiological criteria, the Metropolitana de Belo Horizonte was the most vulnerable mesoregion, with 42.9 and 26.7% of the municipalities in group 5, respectively. Considering the presence of a population at risk, Zona da Mata reported 42.3% of the municipalities in the most vulnerable group. In the joint analysis of data, the Jequitinhonha, Vale do Mucuri and Vale do Rio Doce mesoregions were the most vulnerable in the state of MG. Thus, through the outlined profile, the present study proved how socioeconomic diversity affects the vulnerability of the municipalities to face COVID-19 outbreak, highlighting the need for interventions directed to each reality.

8.
Journal of Heart and Lung Transplantation ; 40(4):S471-S471, 2021.
Article in English | Web of Science | ID: covidwho-1187383
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