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En el mes de Diciembre (2019) se diagnosticó la infección viral que tuvo una rápida expansión. En el mes de Junio (2020) solo en 188 países fueron diagnosticados 35 millones de pacientes. Desgraciadamente en nuestro país los resultados de la atención a los enfermos (diagnostico, aislamiento, atención), fue peor que en otros muchos (Alemania, Italia, Corea, Taiwán, Grecia, Portugal, Francia, Japón y otros). 778 pacientes trasplantados sufrieron la infección, de ellos, 249 en la Comunidad de Madrid. La donación de órganos se redujo rápidamente debido a que las áreas de hospitalización, UCI, quirófanos, actividad hospitalaria en general hubo de dedicarse al tratamiento de los enfermos infectados. Hubo de asumir la reducción de trasplantes de riñón, hígado, corazón, pulmón, en casi el 90% de las cifras correspondientes a los dos años anteriores (en el mes de abril 0%), en el periodo marzo-Julio 2020. No se permitió el trasplante con donante vivo,” Split” o "Cluster”. Solo en la Comunidad de Madrid se realizaron 37 trasplantes menos en 2020 que en 2019. Los motivos de este descenso fue la reducción de camas en UCI, de posibilidades de utilización de quirófanos, menor número de facultativos, enfermeras, personal sanitario en general (861.112 infectados, de los cuales 36.000 eran sanitarios, con una mortalidad global de 36.000). Nuevos protocolos, formas de tratamiento, vacunación, hicieron posible volver a la cifra de trasplantes realizados entre 2018-2019.Alternate : On 31 December 2019 COVID-19 Viral infection was diagnoses. On june 2020 only in 188 countries 33 millons of infected people were detected. Unfortunately in Spain the results of the treatment has been worse than in Germany, Italy, Corea, Taiwan., Grece, Portugal, France, Japan, and others. 778 transplanted patients were infected. 249 of them in Madrid area. Organ donation was reduced. National Organization of Organ Trasplantation diminished donation, and transplantation of kidney, liver, heart, lung close to 90% (in april, 0%) from march to july 2020. Living rolated or split, and cluster trasplantation was not permited. In Madrid area, on 2020 were done 37 transplantation less than in 2019 the causes of that were the reduction of UCI beds, time in the OR, reduction of doctors and nurses. 861.112 infected people, 32.992 died and from the total number of patients, 36.000 were included as, doctors, nurses and other related with health care areas new protocols, hospitals, intensive care areas, etc were established along 2020 going back to the previous results obtained during 2018-2019.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has negatively impacted on patients of the whole CKD spectrum, causing high rates of morbi-mortality. SARS-CoV-2 vaccines opened a new era, but patients with CKD (including kidney transplant, hemodialysis and peritoneal dialysis) were systematically excluded from pivotal clinical trials. The Spanish Society of Nephrology promoted the multicentric national SENCOVAC study aimed at assessing immunological responses after vaccination in patients with CKD. During the first year after vaccination, patients with non-dialysis CKD and those on hemodialysis and peritoneal dialysis presented good anti-Spike antibody responses to vaccination, especially after receiving the third and fourth doses. However, kidney transplant recipients presented suboptimal responses after any vaccination schedule (initial, third and fourth dose). Especially worrisome is the situation of a patients with a persistently negative humoral response that do not seroconvert after boosters. In this regard, monoclonal antibodies targeting SARS-CoV-2 have been approved for high-risk patients, although they may become obsolete as the viral genome evolves. The present report reviews the current status of SARS-CoV-2 vaccination in the CKD spectrum with emphasis on lessons learned from the SENCOVAC study. Predictors of humoral response, including vaccination schedules and types of vaccines, as well as the integration of vaccines, monoclonal antibodies and antiviral agents are discussed.
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Resumen Objetivo: describir un caso de trasplante hepático en un paciente con resultado positivo en la prueba del coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) con éxito en el postrasplante temprano, pero que desarrolló complicaciones asociadas a la inmunosupresión y trombosis portal sin una trombofilia identificada en un centro de alta complejidad de un país latinoamericano. Descripción del caso: paciente de 48 años con diagnóstico de cirrosis hepática secundaria a esteatohepatitis no alcohólica (NASH) complicada por varios episodios de ascitis portal hipertensiva y encefalopatía hepática, ingresada para trasplante hepático ortóptico. En los exámenes iniciales tuvo una prueba positiva para SARS-CoV-2 y era asintomático respiratorio. El trasplante se realizó con éxito luego de la autorización del comité de infección. Después del primer mes posoperatorio presentó diarrea, ascitis y daño renal agudo. Los niveles de tacrolimus en el reingreso fueron superiores a 10 ng/mL y hubo una mejoría clínica significativa con la suspensión del fármaco. Finalmente, el paciente requirió retrasplante por trombosis de la vena porta y de las venas suprahepáticas, aunque no se identificó la etiología. Conclusión: se describe uno de los primeros informes de trasplante de hígado en un paciente con recuperación reciente de COVID-19 y pruebas persistentemente positivas. En el postrasplante temprano hubo una buena respuesta; sin embargo, luego del primer mes presentó complicaciones relacionadas con la inmunosupresión. Este caso también plantea la posible asociación entre el SARS-CoV-2 y el desarrollo de trombosis en la circulación portal hepática.
Abstract Objective: To describe a case of liver transplantation in a patient with a positive result in the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) test with success in the early post-transplantation, but who developed complications associated with immunosuppression and portal vein thrombosis without thrombophilia identified at a tertiary referral center in a Latin American country. Case: A 48-year-old patient diagnosed with liver cirrhosis secondary to non-alcoholic steatohepatitis (NASH) complicated by several episodes of portal hypertension ascites and hepatic encephalopathy was admitted for orthoptic liver transplantation. On initial examinations, he had a positive test for SARS-CoV-2 and was asymptomatic in the respiratory tract. The transplant was carried out successfully after the authorization of the infection committee. After the first postoperative month, he presented with diarrhea, ascites, and acute kidney injury. Tacrolimus levels at readmission were more significant than 10 ng/mL, and there was a significant clinical improvement with drug discontinuation. Finally, the patient required re-transplantation due to thrombosis of the portal vein and suprahepatic veins, although the etiology was not identified. Conclusion: One of the first reports of liver transplantation in a patient with recent recovery from COVID-19 and persistently positive tests is described. In the early post-transplant, there was a good response; however, after the first month, he had complications related to immunosuppression. This case also posits the possible association between SARS-CoV-2 and the development of thrombosis in the hepatic portal circulation.
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Introducción. La pandemia por COVID-19 ha causado la muerte de 6,5 millones de personas en el mundo y la donación de órganos se ha visto ampliamente afectada, reflejándose en una disminución importante en el número de trasplantes. Colombia no ha sido ajena a dicha problemática. Ante este desafío, el Instituto Nacional de Salud ha permitido tomar donantes cadavéricos con reacción en cadena de la polimerasa con transcripción reversa (RT-PCR) positiva para Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), sin enfermedad activa. El objetivo de este estudio fue describir una serie de pacientes trasplantados de riñón con donantes cadavéricos con RT-PCR SARS-CoV-2 positivo y sus principales desenlaces clínicos. Métodos. Serie de casos de pacientes que fueron llevados a trasplante renal con donante cadavérico con SARS-CoV-2 positivo, sin enfermedad activa, entre mayo y agosto de 2022. Se recolectaron las variables demográficas y clínicas y se evaluó la infección y la mortalidad asociada a SARS-CoV-2 en un mes de seguimiento. Resultados. Un total de 5 receptores de trasplante renal con 5 donantes cadavéricos SARS-CoV-2 positivos fueron evaluados. No se presentó mortalidad ni pérdida del injerto renal. Se registraron dos casos de función retardada del injerto y un caso de rechazo agudo. Ninguno de los pacientes presentó RT-PCR SARS-CoV-2 positiva en el seguimiento posterior al trasplante. Conclusión. Con nuestra serie de casos mostramos que el trasplante de riñón proveniente de donante cadavérico con prueba positiva para RT-PCR SARS-CoV-2, sin evidencia de enfermedad COVID-19 activa, es un procedimiento seguro y una estrategia eficaz para aumentar el número de donantes en pandemia
Introduction. Coronavirus Disease-2019 (COVID-19) pandemic have caused the death of 6.5 million of people worldwide. The organ donation was extremely affected reflecting in the number of transplants. Colombia has not been immune to this problem. Facing this challenge, the National Institute of Health (Instituto Nacional de Salud, INS) allowed to assign cadaveric donors with reverse transcription-polymerase chain reaction (RT-PCR) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive without COVID-19. We aim to describe a case series of kidney transplant patients with RT-PCR SARS-CoV-2 positive cadaveric donors, and their main clinical outcomes. Methods. A case series of five patients who underwent kidney transplantation of cadaveric donors with positive RT-PCR SARS-CoV-2 during the study period from May to august of 2022. Demographics and clinical characteristics were collected from the institutional medical records, and we evaluated the mortality and infection associated with SARS-CoV-2. Results. A total of five kidney transplant recipients and five cadaveric donors with positive RT-PCR SARS-CoV-2 were described in the present study. There were not mortality reported and none of the patients had graft loss. Two cases of delayed graft function and one case of acute kidney rejection were documented. None of the patients had positive RT-PCR SARS-CoV-2 in the follow-up. Conclusion. Our series demonstrated that the kidney transplant of cadaveric donors with positive RT-PCR SARS-CoV-2 without clinical evidence of active COVID-19 disease is a safe procedure and an efficient strategy to increase donors during a pandemic
Subject(s)
Humans , Kidney Transplantation , Coronavirus Infections , Donor Selection , Tissue and Organ Procurement , PandemicsABSTRACT
Objetivo Describir la tasa de mortalidad de infección por coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, en inglés) y los factores de riesgo asociados a la severidad de la enfermedad en pacientes con trasplante renal de un centro del nordeste colombiano. Materiales y Métodos Estudio descriptivo de una cohorte de pacientes en seguimiento postrasplante renal, en el que se hizo una búsqueda retrospectiva de los que presentaron infección por SARS-CoV-2 entre marzo del 2020 y mayo del 2021. Para el análisis, se incluyeron los pacientes con infección confirmada mediante pruebas de reacción en cadena de la polimerasa (polymerase chain reaction, PCR, en inglés), de antígenos, o de anticuerpos. Se realizoÌ un análisis descriptivo de las variables sociodemográficas y clínicas, y un análisis bivariado de los posibles factores asociados con el riesgo de mortalidad. Resultados Con un total de 307 individuos en seguimiento, se encontró una prevalencia del 14,3% (n = 44) de infección por enfermedad por coronavirus 2019 (coronavirus disease 2019, COVID-19, en inglés). La media de edad fue de 56 años, con predominio del género masculino. El esquema de inmunosupresión más frecuente fue micofenolatotacrolimusprednisona. Entre los pacientes infectados, la mortalidad fue del 34,1% (15/44), lo que representa el 4,8% de toda la población a estudio. Maás de la mitad de los pacientes requirieron hemodiálisis, y en el 86,7% fue necesario hacer ajustes en el esquema de inmunosupresión. Conclusión La prevalencia de infección por SARS-CoV-2 en nuestro grupo de trasplantes fue similar a la reportada por otros grupos de trasplante del país, y mayor a la de la población no trasplantada. El valor de creatinina previo a la infección, la edad y las comorbilidades se asociaron con un mayor riesgo de mortalidad.
Objective To describe the mortality related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk factors associated with disease severity in patients submitted to a kidney transplant from a center in northeastern Colombia. Materials and Methods The present is a descriptive study of a cohort of patients in follow-up care after kidney transplant, with a retrospective search for those who presented SARS-CoV-2 infection between March 2020 and May 2021. Patients with confirmed infection by polymerase chain reaction (PCR), antigens or antibodies tests were included for analysis. We performed a descriptive analysis of the sociodemographic and clinical variables as well as a bivariate analysis to evaluate the possible factors associated with the risk of mortality. Results With a total of 307 individuals in follow-up care, a prevalence of 14.3% (n = 44) of coronavirus disease 2019 (COVID-19) infection was found. The mean age of the sample was of 56 years, with a male predominance. The most frequent immunosuppression regimen was mycophenolate-tacrolimus-prednisone. Among the infected patients, the mortality rate was of 34.1% (15/44), representing 4.8% of the entire study population. More than half of the patients required hemodialysis, and 86.7% required adjustments to the immunosuppression regimen. Conclusion The prevalence of SARS-CoV-2 infection in our transplant group was similar to that reported by other transplant groups in the country and higher than among the non-transplanted population. The preinfection creatinine value, age, and comorbidities were associated with a higher risk of mortality.
Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis , Kidney Transplantation , Coronavirus , Severe Acute Respiratory Syndrome , SARS-CoV-2 , COVID-19 , Severity of Illness Index , Adaptation, Psychological , Polymerase Chain Reaction , Risk Factors , Immunosuppression Therapy , AntigensABSTRACT
BACKGROUND: The impact of immunosuppression in solid organ transplant recipients with SARS-CoV-2 infection is unknown. The knowledge about the behavior of different immunosuppression schemes in clinical outcomes is scarce. This study aimed to determine the risk of death in kidney transplant recipients with COVID-19 under two different schemes of immunosuppression. METHODS: We describe our experience in kidney transplant recipients with SARS-CoV-2 infection in seven transplant centers during the first year of the pandemic before starting the vaccination programs in the city of Bogotá. Demographic characteristics, clinical presentation, immunosuppression schemes at presentation, and global treatment strategies were compared between recovered and dead patients; survival analysis was carried out between calcineurin inhibitors based regimen and free calcineurin inhibitors regimen. RESULTS: Among 165 confirmed cases, 28 died (17%); the risk factors for mortality identified in univariate analysis were age older than 60 years (p=.003) diabetes (p=.001), immunosuppression based on calcineurin inhibitors (CNI) (p=.025) and patients receiving steroids (p=.041). In multivariable analysis, hypoxemia (p=.000) and calcineurin inhibitors regimen (p=.002) were predictors of death. Survival analysis showed increased mortality risk in patients receiving CNI based immunosuppression regimen vs. CNI free regimens mortality rates were, respectively, 21.7% and 8.5% (p=.036). CONCLUSIONS: Our results suggest that the calcineurin inhibitors probably do not provide greater protection compared to calcineurin inhibitor free schemes being necessary to carry out analyzes that allow us to evaluate the outcomes with different immunosuppression schemes in solid organ transplant recipients with SARS-CoV-2 infection.
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Resumen La pandemia por COVID19 afectó a los programas de trasplante al disminuir el número de procedimientos realizados, y aunque ya se han reiniciado, la falta de donantes es una limitante, ante la posibilidad de transmisión del virus. Actualmente en condiciones especiales se han realizado trasplantes a partir de donantes positivos a SARS-CoV-2. Presentamos el caso de paciente masculino de 58 años con falla cardiaca refractaria secundaria a defectos septal interventricular residual posinfarto quien recibió corazón a partir de donante de 16 años, asintomático, positivo a SARS-CoV-2. El procedimiento realizado sin complicaciones, con evolución posoperatoria favorable, egresa a los 15 días postrasplante. Actualmente asintomático y sin evidencia de infección por SARS-CoV-2. Se trata del primer caso en México realizado en estas condiciones. The COVID19 pandemic affected transplant programs by decreasing the number of procedures performed. Although they have already restarted, the lack of donors is a limitation, given the possibility of transmission of the virus. Currently, transplants have been performed under special conditions from SARS-CoV-2 positive donors. We present the case of a 58-year-old male patient with refractory heart failure secondary to residual postinfarction interventricular septal defects who received heart from a 16-year-old asymptomatic, SARS-CoV-2-positive donor. The procedure was performed without complications, with favorable postoperative evolution, discharged 15 days posttransplant. Currently asymptomatic and with no evidence of SARS-CoV-2 infection. This is the first case in Mexico carried out under these conditions.
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Background: Since the beginning of the SARS-CoV-2 pandemic, identifying the COVID-19 pathophysiology not only has been addressed to applying diagnostic tests or preventing through vaccines, but also to the timely detection, especially of patients in risk groups such as those in transplants areas (renal, hematology, etcetera). In the case of these patients, using RT-PCR tests avoids putting them at risk by subjecting them to states of immunosuppression that could aggravate their situation if they were faced with an onset of a COVID-19 infection. Objective: To present the results of patients of a transplant unit tested for SARS-CoV-2. Material and methods: Descriptive, observational, crosssectional, and retrolective study. Data of results of RT-PCR tests of patients who underwent transplantation from June 2021 to April 2022 in a third level hospital were collected. Results: 755 tests were done to patients who underwent transplantation. 384 (50.8%) were women. Out of all patients, only 73 (9.7%) were positive to SARS-CoV-2. Conclusions: Implementing RT-PCR tests as a transplant protocol to detect SARS-CoV-2 prevents fatal complications due to COVID infection to donors and receptors. (English) [ FROM AUTHOR]
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Introducción: La infección por coronavirus favorece el desarrollo de alteraciones respiratorias. En trasplantados renales el pronóstico de la neumonía por SARS-CoV-2 puede ser diferente al resto de la población. Muchos pacientes trasplantados tienen de base linfopenia inducida por fármacos, por lo que la detección y el tratamiento precoz son determinantes en este grupo de población. Presentación del caso: Varón de 50 años con ERC no filiada, trasplantado renal en 2016 que acudió a urgencias por fiebre de 38ºC, tos, rinorrea, diarrea con pérdida de peso y molestia en injerto renal en fosa iliaca derecha. Se diagnosticó de COVID-19 positivo tras realización de placa de tórax y PCR SARS-CoV-2. Ingresó en nuestra unidad de trasplante renal. Plan de cuidados: Se realizó una valoración inicial mediante los patrones funcionales de Gordon. Posteriormente identificamos Diagnósticos de Enfermería según la taxonomía NANDA con sus correspondientes criterios de resultados e intervenciones. Evaluación del plan: Tras la realización de las intervenciones y la evaluación de los indicadores de resultados observamos una disminución de la temperatura corporal y de la dificultad respiratoria con mejoría en el patrón respiratorio. En cuanto a la función renal, no se ha visto significativamente alterada a pesar de la retirada temporal de la inmunosupresión. Conclusión: El paciente se fue de alta con una función renal similar a la previa y con la inmunosupresión reintroducida. Se lograron los objetivos planteados dejando patente que el papel de enfermería ha sido fundamental en el proceso de recuperación y afrontamiento de la enfermedad.Alternate : Introduction: Coronavirus infection favours the development of respiratory disorders. In kidney transplant patients, the prognosis of SARS-CoV-2 pneumonia may be different from the rest of the population. Many transplant patients have drug-induced lymphopenia, so early detection and treatment are crucial in this population group. Case description: A 50-year-old man with unknown CKD and a kidney transplant in 2016 who came to the emergency room due to fever of 38ºC, cough, rhinorrhea, diarrhea with weight loss and discomfort in a kidney graft in the right iliac fossa. He was diagnosed with COVID-19 positive after performing a chest X-ray and SARS-CoV-2 PCR. He was admitted to our kidney transplant unit. Description of the care plan: An initial assessment was made using Gordon’s functional patterns. Subsequently, we identify Nursing Diagnoses according to the NANDA taxonomy with their corresponding outcome and intervention criteria. Evaluation of the care plan: After carrying out the interventions and evaluating the outcome indicators, we observed a decrease in body temperature and respiratory distress with improvement in the respiratory pattern. Regarding renal function, it has not been significantly altered despite the temporary withdrawal of immunosuppression. Conclusion: The patient is discharged with a renal function similar to the previous one and with reintroduced immunosuppression. The objectives set were achieved, making it clear that the role of nursing has been vital in the process of recovery and coping with the disease.
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La infección por el SARS-CoV-2 (COVID-19) ha supuesto un importante impacto en la actividad trasplantadora en nuestro país. En su condición de paciente inmunodeprimido y con frecuentes comorbilidades, era esperable que la mortalidad y el riesgo de complicaciones asociadas a la COVID-19 en el receptor de trasplante renal (TR) fueran mayores en comparación con la población general, si bien la información al respecto en los primeros meses de la pandemia era muy limitada. Desde marzo de 2020 hemos mejorado rápidamente nuestro conocimiento acerca de la epidemiología, características clínicas y manejo de la COVID-19 post-trasplante. La presente revisión pretende recopilar la información disponible a julio de 2021 en respuesta a una serie de cuestiones relevantes: ¿cómo se manifiesta clínicamente la infección por SARS-CoV-2 en receptores de TR?, ¿cuáles son sus factores pronósticos?, ¿es más grave la COVID-19 en el contexto del TR respecto a los pacientes inmunocompetentes?, ¿de qué opciones de tratamiento antiviral disponemos actualmente para el receptor de TR?, ¿cuál es la experiencia disponible con los tratamientos inmunomoduladores? y, por último, ¿son eficaces las vacunas frente a la COVID-19 basadas en ARN mensajero en esta población?. A pesar de los avances realizados, aún son varios los aspectos que debemos mejorar en nuestro abordaje de la infección por SARS-CoV-2 en el ámbito específico del TR.Alternate : SARS-CoV-2 infection (COVID-19) has profoundly impacted transplant activity in our country. As immunocompromised hosts with common comorbidities, kidney transplant (KT) recipients were expected to have higher mortality and risk of complications associated to COVID-19 compared to the overall population. The available experience at the beginning of the pandemic, however, was very limited. Since March 2020 our knowledge on the epidemiology, clinical features and management of post-transplant COVID-19 has rapidly evolved. The present review is aimed at summarizing the information generated by July 2021 to answer a number of relevant questions: How does SARS-CoV-2 infection present in KT recipients? What are the prognostic factors? Does COVID-19 entail a worse prognosis in the setting of KT as compared to non-immunocompromised individuals? What are the antiviral agents currently available for KT recipients? What is the experience with the use of immunomodulatory therapies? And lastly, are mRNA-based COVID-19 vaccines effective in this patient population? Despite notable advances achieved, we should still improve various aspects of our approach to SARS-CoV-2 infection in the specific setting of KT.
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En diciembre de 2019, apareció un nuevo coronavirus que ha dado lugar a una pandemia. Dadas las características del paciente trasplantado, se hace necesario conocer cuál ha sido la repercusión respecto a la infección por SARS-CoV-2, planteándonos como objetivo describir la incidencia de SARS-CoV-2 en pacientes con un trasplante renal. Se llevó a cabo un estudio observacional de cohorte retrospectiva de pacientes con un trasplante renal y que están en seguimiento por la consulta de trasplantes de un hospital terciario, durante el periodo comprendido entre el 1 de marzo de 2020 y el 1 de marzo de 2021. Se incluyeron 604 individuos, con una edad media de 61,6±12,8 años. Un 62,3% (n=376) fueron hombres. La incidencia por SARS-CoV-2 fue 14,9% (n=90). La mortalidad por SARS-CoV-2 fue 3,8% (n=23) lo que supone una letalidad del 25,5%. Al comparar si han pasado la infección en función del sexo no se encontraron diferencias significativas. Tampoco al comparar en función de la edad media, que fue de 60,9±11,8 años en los infectados y de 61,7±12,9 años en los no infectados. Se encontraron diferencias significativas (p=0,005) al comparar la media de años transcurridos desde el trasplante;que fue de 8,7±5,6 años en los infectados y de 11 ±7,3 años en los no infectados. La incidencia de infección por SARS-CoV-2 encontrada en personas con TR fue muy superior a la descrita para la población general. La letalidad y la mortalidad también fueron mayores que en la población general, pero acordes con otras poblaciones de individuos con TR.Alternate : In December 2019, a new coronavirus appeared and generated a pandemic. Considering the characteristics of the transplanted patient, it is relevant to know the impact regarding SARS-CoV-2 infection, aiming to describe the incidence of SARS-CoV-2 in renal transplant patients. A retrospective observational cohort study of patients with a renal transplant and under follow-up by the transplant clinic of a tertiary hospital was conducted during the period from 1 March 2020 to 1 March 2021. A total of 604 individuals were included, with a mean age of 61.6 ±12.8 years. 62.3% (n=376) were men. SARS-CoV-2 incidence was 14.9% (n=90). Mortality due to SARS-CoV-2 was 3.8% (n=23), giving a case fatality of 25.5%. No significant differences were found according to sex and age, being 60.9±11.8 years in those infected and 61.7±12.9 years in those not infected. Significant differences (p=0.005) were found for the mean number of years since transplantation;8.7±5.6 years in those infected and 11±7.3 years in those not infected. The incidence of SARS-CoV-2 infection in renal transplant recipients was much higher than that described for the general population. Case fatality and mortality were also higher than in the general population, but in line with other series of individuals with renal transplantation.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide over the last year causing more than one million deaths. Several treatments have tried to modify the natural history of the coronavirus disease 2019 (COVID-19) but only corticosteroids have demonstrated to be effective in moderate or severe affectation. In that situation, the development of vaccines for preventing the SARS-CoV-2 infection has focused the attention of the scientific community. At present, available messenger RNA-based technology vaccines have received the approval of local and international sanitary authorities. In this position statement, the Spanish Society of Nephrology wants to state that patients with chronic kidney disease and healthcare workers are at high-risk for contagion and complications of COVID-19 so they must have priority in the vaccine administration.
Subject(s)
COVID-19 , Nephrology , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Humans , RNA, Messenger , SARS-CoV-2ABSTRACT
The uptake of the current concept of chronic kidney disease (CKD) by the public, physicians and health authorities is low. Physicians still mix up CKD with chronic kidney insufficiency or failure. In a recent manuscript, only 23% of participants in a cohort of persons with CKD had been diagnosed by their physicians as having CKD while 29% has a diagnosis of cancer and 82% had a diagnosis of hypertension. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. A prevalent view is that for those in whom kidneys fail, the problem is "solved" by dialysis or kidney transplantation. However, the main burden of CKD is accelerated aging and all-cause and cardiovascular premature death. CKD is the most prevalent risk factor for lethal COVID-19 and the factor that most increases the risk of death in COVID-19, after old age. Moreover, men and women undergoing KRT still have an annual mortality which is 10-100-fold higher than similar age peers, and life expectancy is shortened by around 40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth global cause of death by 2040 and the second cause of death in Spain before the end of the century, a time when 1 in 4 Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded CIBER network research structure in Spain. Leading Spanish kidney researchers grouped in the kidney collaborative research network REDINREN have now applied for the RICORS call of collaborative research in Spain with the support of the Spanish Society of Nephrology, ALCER and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true. However, only the highest level of research funding through the CIBER will allow to adequately address the issue before it is too late.
Subject(s)
COVID-19 , Nephrology , Renal Insufficiency, Chronic , Adult , Cost of Illness , Female , Humans , Male , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Renal Replacement TherapyABSTRACT
BACKGROUND: Remdesivir is the only antiviral treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Its effects in Kidney transplant (KT) patients are limited to some published cases. METHODS: We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and December 31, 2020 with SARS-CoV-2 pneumonia who received remdesivir. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir. DISCUSSION: A total of 37 KT patients developed SARS-CoV-2 infection, 7 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. 4 were men, the median age was 59 (53-71) years. Median time from transplantation was 43 (16-82) months. Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 3 cases. Only 2 cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. 2 patients rise up 1.5 times the liver function test. No patient died or required admission to the critical care unit. Median days of admission was 12 (9-27) days. CONCLUSIONS: Our study suggests that the use of remdesivir could be useful in KT patients with SARS-CoV-2 pneumonia without side effects. Additional studies are necessary with a larger number of patients to improve the knowledge of this drug in SARS-CoV-2 infection.
Subject(s)
COVID-19 Drug Treatment , Kidney Transplantation , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Anticoagulants , Antiviral Agents/adverse effects , Dexamethasone , Female , Humans , Male , Middle Aged , Oxygen , SARS-CoV-2ABSTRACT
INTRODUCTION AND OBJECTIVES: This report updates the annual data of the Spanish Heart Transplant Registry with the procedures performed in 2021. METHODS: We describe the clinical profile, therapeutic characteristics and outcomes in terms of survival of the procedures performed in 2021. Their temporal trends are updated for the 2012 to 2020 period. RESULTS: In 2021, 302 heart transplants were performed (8.6% increase versus 2020). The tendency in 2021 confirmed that of prior years, with fewer urgent transplants and a preference for the use of ventricular assist devices. The remaining characteristics and survival showed a clear trend toward stability in the last decade. Compared with 2019, the SARS-CoV-2 pandemic (2020 and 2021) did not affect short- or long-term survival. CONCLUSIONS: In 2021, transplant activity returned to prepandemic levels. The SARS-CoV-2 pandemic did not significantly affect transplant outcomes. The main transplant features and outcomes have clearly stabilized in the last decade.
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Abstract Background: Children undergoing hematopoietic stem cell transplant (HSCT) can develop respiratory viral infections (RVI) during fever episodes. There are few data about clinical outcomes in RVI and compared to bacterial infections (BI) in this population. Aim: To determine clinical outcome of RVI, compared to BI in children with HSCT. Methods: Prospective study, patients ≤ 18 years with cancer and HSCT admitted with fever at a National Bone Marrow Transplant Center (Hospital Calvo Mackenna), Chile, (April-2016 to May-2019). Clinical assessment, laboratory tests, blood cultures, nasopharyngeal sample for multiplex-PCR (Filmarray®), viral loads by PCR and cytokine panel (Luminex®, 38 cytokines) were performed. The following outcomes were evaluated: upper/lower respiratory tract disease (RTD), admission to ICU, mechanical ventilation, mortality and antimicrobial withdrawal. Results: Of 56 febrile episodes, 35 (63%) were RVI, 12 (21%) BI and 9 (16%) with unknown etiology (UE). Median of age was 8.5 years, 62% male gender. Rhinovirus (54%) and coronavirus (15%) were the more frequent detected viruses. No significant differences in cytokine levels were observed between RVI and BI. 94% of RVI patients had symptomatic RTD, versus 33% in BI and 33% in UE group (p < 0.001), with lower-RTD in 69% of RVI group (p < 0,001). Admission to ICU was 11% in RVI, 17% in BI and 11% in UE group (p = 0.88);only 2 patients required mechanical ventilation (p = 0.37) and no mortality was reported. After an RVI was detected by PCR, antimicrobials were withdrawal in 26% of patients with RVI (p: 0.04). Conclusion: RVI are frequent etiologic agents in febrile episodes of patients with HSCT. Viral detection might help to rationalize the use of antimicrobials in this population.
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Resumen Introducción y objetivos Se actualizan los datos anuales de Registro Español de Trasplante Cardiaco con los hallazgos de los procedimientos realizados en 2021. Métodos Se describen las principales características clínicas, del tratamiento recibido y de los resultados en términos de supervivencia del año 2021 y las tendencias en el periodo 2012-2020. Resultados En 2021 se han realizado 302 trasplantes cardiacos (un 8,6% más que el año anterior). En 2021 se ha confirmado la tendencia observada en años anteriores a una disminución de los trasplantes urgentes y a la realización de estos mayoritamente con dispositivos de asistencia ventricular. Las demás características y los resultados en términos de supervivencia muestran una clara tendencia a la estabilización en la última década. Respecto a 2019, en los años de la pandemia por SARS-CoV-2 (2020 y 2021) no se detecta un impacto relevante en los resultados en la fase aguda tras el trasplante y en la serie histórica. Conclusiones En 2021 se ha recuperado la actividad de trasplante hasta cifras previas a la pandemia por SARS-CoV-2, que no ha tenido un impacto global significativo en los resultados. Las características del procedimiento y los resultados muestran una clara tendencia a la estabilización en la última década. Introduction and objectives This report updates the annual data of the Spanish Heart Transplant Registry with the procedures performed in 2021. Methods We describe the clinical profile, therapeutic characteristics and outcomes in terms of survival of the procedures performed in 2021. Their temporal trends are updated for the 2012 to 2020 period. Results In 2021, 302 heart transplants were performed (8.6% increase versus 2020). The tendency in 2021 confirmed that of prior years, with fewer urgent transplants and a preference for the use of ventricular assist devices. The remaining characteristics and survival showed a clear trend toward stability in the last decade. Compared with 2019, the SARS-CoV-2 pandemic (2020 and 2021) did not affect short- or long-term survival. Conclusions In 2021, transplant activity returned to prepandemic levels. The SARS-CoV-2 pandemic did not significantly affect transplant outcomes. The main transplant features and outcomes have clearly stabilized in the last decade.
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OBJECTIVES: In the past decade, advances in immunological therapy have increased the survival of kidney recipients and their grafts. However, it has not achieved the desired level of improvement. This study aims to reveal the mortality among kidney recipients. METHODS: Medical data of the patients, who had undergone kidney transplantation (KT) between November 2010 and December 2020, were retrospectively reviewed. Inclusion criteria were adult kidney recipients, who had died. Exclusion criteria were pediatric recipients, recipients of en bloc and dual KT, recipients with missing data, and recipients with a primary non-functioning graft. The recipients were grouped according to their donor type; Group 1 (from a living donor) and Group 2 (from a deceased donor). Subgroup analyses were done for mortality by time-period post-transplant and for infectious causes of mortality. RESULTS: Of 314 recipients, 35 (11.14%) died. Twenty-nine recipients were included in the study (Group 1: 17 and Group 2: 12). The most common cause of mortality was infection (58.6%), and the second was cardiovascular disease (CVD) (24.1%). Sepsis developed in 29.4% of infection-related deaths, while COVID-19 constituted 23.5% of infection-related deaths. CONCLUSION: Early diagnosis and treatment of infectious and CVD are important to improve survival in kidney recipients.
OBJETIVOS: En la última década, los avances en la terapia inmunológica han aumentado la supervivencia de los receptores de riñón y sus injertos. Sin embargo, no se pudo lograr el nivel de mejora deseado. Este estudio tiene como objetivo revelar la mortalidad entre los receptores de riñón. MATERIALES Y MÉTODOS: Se revisaron retrospectivamente los datos médicos de los pacientes, que se habían sometido a un trasplante de riñón entre Noviembre de 2010 y Diciembre de 2020. Los criterios de inclusión fueron los receptores de riñón adultos, que habían fallecido. Los criterios de exclusión fueron los receptores pediátricos, los receptores de trasplantes de riñón dual y en bloque, los receptores con datos faltantes y los receptores con un injerto primario no funcionante. Los receptores se agruparon según su tipo de donante; Grupo 1 (de un donante vivo) y Grupo 2 (de un donante fallecido). Se realizaron análisis de subgrupos para la mortalidad por período de tiempo posterior al trasplante y para las causas infecciosas de mortalidad. RESULTADOS: De 314 beneficiarios, 35 (11,14%) fallecieron. Se incluyeron 29 receptores en el estudio (Grupo 1:17; Grupo 2:12). La causa más común de mortalidad fue la infección (58,6%) y la segunda fue la enfermedad cardiovascular (24,1%). La sepsis se desarrolló en el 29,4% de las muertes relacionadas con la infección, mientras que el COVID-19 constituyó el 23,5% de las muertes relacionadas con la infección. CONCLUSIÓN: El diagnóstico y tratamiento tempranos de enfermedades infecciosas y cardiovasculares es importante para mejorar la supervivencia de los receptores de riñón.
Subject(s)
COVID-19 , Kidney Transplantation , Adult , Child , Graft Survival , Humans , Living Donors , Retrospective StudiesABSTRACT
OBJECTIVE: To identify the available information to support registered nurses' clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic. METHOD: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed. RESULTS: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines. DISCUSSION: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients. CONCLUSION: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.
Subject(s)
COVID-19 , Humans , Pandemics , Quality of Life , SARS-CoV-2 , Tissue DonorsABSTRACT
We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.