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1.
Transplantation Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-1616800

ABSTRACT

Background Covid-19 causes a wide range of symptoms, with particularly high risk of severe respiratory failure and death in patients with predisposing risk factors such as advanced age or obesity. Recipients of solid organ transplants, and in particular lung transplantation, are more susceptible to viral infection due to immune suppressive medication. As little is known about the SARS-CoV-2 infection in these patients, this study was undertaken to describe outcomes and potential management strategies in early COVID-19 infection early after lung transplantation. Methods We describe the incidence and outcome of COVID-19 in a cohort of recent lung transplant recipients in Munich. Six of 186 patients who underwent lung transplantation in the period between March 2019 until March 2021 developed COVID-19 within the first year after transplantation. We documented the clinical course and laboratory changes for all patients showing differences in the severity of the infection with COVID-19 and their outcomes. Results Three of six SARS-CoV-2 infections were hospital-acquired and the patients were still in inpatient treatment following lung transplantation. All patients suffered from symptoms. One patient did not received antiviral therapy. Remdesivir was prescribed in four patients and the remaining patient received remdesivir, bamlanivimab and convalescent plasma. Conclusion COVID-19 does not appear to cause milder disease in lung transplant recipients compared to the general population. Immunosuppression is potentially responsible for the delayed formation of antibodies and their premature loss. Several comorbidities and a general poor preoperative condition showed an extended hospital stay.

2.
Thorac Cardiovasc Surg ; 69(1): 92-94, 2021 01.
Article in English | MEDLINE | ID: covidwho-752412

ABSTRACT

The current COVID-19 pandemia affects health care systems worldwide, however, to a variable extent depending on the caseload in each country. We aimed to provide a cross-sectional overview of current limitations or adaptions in lung transplant programs in Germany in from January to May 2020 due to the COVID-19 pandemia caused by severe acute respiratory syndrome coronavirus 2. A cross-sectional survey assessing various aspects of lung transplant activity was sent to all active lung transplant programs (n = 12) in Germany. Eight centers (66%) responded to the survey within the requested time frame. Four centers (50%) reported their activity is not restricted at all and four centers (50%) reported on moderate general limitations. The overall lung transplant activity in Germany from January to May 2020 contains 128 bilateral and 11 single lung transplantations, which is similar to the same period in the year 2019 (126 bilateral transplantations and 12 single lung transplantations). The results suggest that the influence of the COVID-19 pandemia on lung transplantation activity in Germany has been moderate so far. Nevertheless, adaptions such as extensive testing of donors and recipients were introduced to reduce the likelihood of infections and increase patient safety. Alertness to changes in COVID-19 reproduction rates might be required until effective antiviral therapy or vaccination is available.


Subject(s)
COVID-19 , Lung Transplantation/trends , Cross-Sectional Studies , Donor Selection/trends , Germany , Health Care Surveys , Humans , Lung Transplantation/adverse effects , Patient Safety , Risk Assessment , Risk Factors , Time Factors , Tissue Donors/supply & distribution , Waiting Lists/mortality
3.
Clin Transplant ; 34(10): e14027, 2020 10.
Article in English | MEDLINE | ID: covidwho-615069

ABSTRACT

Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection. The specific features of coronavirus disease 2019 (COVID-19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Seven transplanted patients (two liver, three kidneys, one double lung, one heart) admitted to the Ludwig-Maximilians-University Munich because of COVID-19 and tested positive for SARS-CoV-2 were included. The clinical course and the clinical findings were extracted from the medical record. The two liver transplant patients and the heart transplant patient had an uncomplicated course and were discharged after 14, 18, and 12 days, respectively. Two kidney transplant recipients were intubated within 48 hours. One kidney and the lung transplant recipients were required to intubate after 10 and 15 days, respectively. Immunosuppression was adapted in five patients, but continued in all patients. Compared to non-transplanted patients at the ICU (n = 19) the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL-6 blood values. This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS-CoV-2, their clinical course seems to be similar to immunocompetent patients.


Subject(s)
COVID-19/immunology , Graft Rejection/prevention & control , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Inflammation/immunology , Organ Transplantation , Postoperative Complications/immunology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Testing , Drug Administration Schedule , Female , Graft Rejection/immunology , Humans , Immunosuppressive Agents/therapeutic use , Inflammation/diagnosis , Inflammation/therapy , Inflammation/virology , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Postoperative Complications/virology , Prognosis , Retrospective Studies , Severity of Illness Index , Young Adult
4.
Am J Transplant ; 20(10): 2928-2932, 2020 10.
Article in English | MEDLINE | ID: covidwho-268563

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has become a global health problem with pandemic character. Lung transplant recipients may be particularly at risk due to the high degree of immunosuppression and the lung being the organ primarily affected by COVID-19. We describe a 16-year-old male and a 64-year-old female recently lung transplanted patients with COVID-19 during inpatient rehabilitation. Both patients were receiving triple immunosuppressive therapy and had no signs of allograft dysfunction. Both patients had close contact with a person who developed COVID-19 and were tested positive for SARS-CoV-2. Subsequently, both patients underwent systematic screening and SARS-CoV-2 was ultimately detected. Although the 16-year-old boy was completely asymptomatic, the 64-year-old woman developed only mild COVID-19. Immunosuppressive therapy was unchanged and no experimental treatment was initiated. No signs of graft involvement or dysfunction were noticed. In conclusion, our report of patients with asymptomatic SARS-CoV-2 infection and mild COVID-19, respectively, may indicate that lung transplant recipients are not per se at risk for severe COVID-19. Further observations and controlled trials are urgently needed to study SARS-CoV-2 infection in lung transplant recipients.


Subject(s)
Antiviral Agents/therapeutic use , Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Lung Transplantation , Pneumonia, Viral/diagnosis , Transplant Recipients , Adolescent , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/transmission , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/transmission , Postoperative Period , RNA, Viral/analysis , SARS-CoV-2 , Tomography, X-Ray Computed
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