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1.
J Rural Stud ; 95: 533-543, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2105479

ABSTRACT

California agricultural workers are predominately Latino/a, are medically underserved, and reside in larger households, placing them at elevated COVID-19 risk at work and at home. While some research has examined COVID-19 among agricultural workers in the interior of the United States, little research exists on experiences of COVID-19 along the US-Mexico border. Grounded in resilience thinking, this study aims to understand how agricultural workers navigated their heightened risk to COVID-19 at work and at home, and made use of available resources in the context of a bi-national community. Our study utilized qualitative interviews with 12 agricultural workers to understanding the COVID-19 experiences of resident and daily migrant agricultural workers in Imperial County, California, located along the US-Mexico border. Findings suggest that agricultural workers faced significant impacts and risks at work (work stoppages, stress about bringing COVID-19 home to family) and at home (contracting COVID-19, loss of friends and family, and mental health challenges). Agricultural workers and their employers often implemented COVID-19 precautions such as social distancing measures, personal protective equipment, hand washing and hand sanitizers, and isolation. Many agricultural workers did access testing resources on either side of the US-Mexico border and worked with US-based Spanish-speaking community-based organizations to register for vaccine appointments. To better support agricultural workers and their employers in the future, we recommend the following: 1. Prioritize agricultural workplace conditions to increase agricultural worker physical and mental health, 2. Extend public health services into agricultural work sites of transit and the workplace, and 3. Lastly, trusted Spanish-speaking community-based organizations can play a critical role in public health outreach.

2.
Comedia Performance ; 19(1):85-100, 2022.
Article in English | Web of Science | ID: covidwho-2072073

ABSTRACT

This article discusses two collaborative theatre projects developed virtually due to COVID-19 restrictions during the 2020-2021 academic year. These projects- Medieval Ballads in Miniature: A Shadow of Myself and Our New Gold-highlight the dynamics of theatrical collaboration outside the traditional performing arts setting or classroom and show how these can be truly synergistic and enriching for academic and non-academic audiences.

3.
Multiple Sclerosis and Related Disorders ; : 104240, 2022.
Article in English | ScienceDirect | ID: covidwho-2069502

ABSTRACT

Background : Previous studies have demonstrated higher MS incidence and prevalence in PR than in other Caribbean and Latin American countries. Our objectives are to update the epidemiologic trends in MS incidence and prevalence rates for Puerto Rico (PR) from 2017 through 2020 and compare them to prior rate data from 2013 to 2016. Methods : We used the Puerto Rico MS Foundation's registry (PRMS Registry) data to identify all newly diagnosed MS cases between January 2017 and December 2020. The study population included 568 MS patients, 406 women, and 162 men living in PR. All individuals were 18 years and older and met the 2017 revised McDonald criteria for MS diagnosis. In addition, age- and sex-standardized incidence rates were estimated. Results : In terms of results, 568 new MS cases were diagnosed in Puerto Rico between 2017 and 2020. The 2020 MS cumulative prevalence for Puerto Rico was 95.3/100,000 (95% CI 91.6, 99.1), higher than previously reported. The age- and sex-standardized MS incidence rate for Puerto Rico decreased from 6.5/100,000 (2017) to 6.3/100,000 (2020). The annual age-standardized MS incidence rates declined for females: from 9.5/100,000 (2017) to 8.2/100,000 (2020) but increased for males from 3.6/100,000 to 4.6/100,000 during the same period. Conclusion : These incidence and prevalence rates are among the highest reported among Caribbean and Latin American countries. A peak in the age- and sex-standardized MS incidence rate was observed after hurricane María (2018) and a decline during the first year of the COVID-19 pandemic (2020). Further investigation is needed to determine whether there was a causal relationship between the fluctuations observed and those natural events.

4.
Journal of Mental Health Counseling ; 44(4):343-361, 2022.
Article in English | Academic Search Complete | ID: covidwho-2067415

ABSTRACT

The COV1D-19 pandemic has had an unprecedented impact on mental health. The current study examined symptoms of depression and anxiety and sociodemographic factors associated with increased symptoms among 1,242 adults under the same state-issued stay-at-home mandate. Mean anxiety and depression scores were 58.07 ± 9.6 and 55.18 ± 10.49, with the majority of participants indicating clinically significant symptoms of anxiety (n = 831, 66.90%) and depression (n = 652, 52.49%). African American and Latino/a American participants, individuals under the age of 45, and unemployed individuals or persons working in professional jobs presented with the most significant risk for adverse outcomes. Implications highlight the vital role of clinical mental health counselors in supporting at-risk populations and the need for future research supporting prevention-based, culturally appropriate screening and treatment protocols. [ FROM AUTHOR] Copyright of Journal of Mental Health Counseling is the property of American Mental Health Counselors Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

5.
Clinical Medicine ; 22(5):416-422, 2022.
Article in English | ProQuest Central | ID: covidwho-2067213

ABSTRACT

KEYWORDS: clinical trial, public knowledge, recruitment Introduction Over the past 3 decades, researchers have consistently documented disparities in clinical trial participation.1,2 For instance, clinicatl trials that have been used to support the US Food and Drug Administration approval of drugs have shown an underrepresentation of Black / African American and Hispanic/Latinx participants.3,4 Representative participation in clinical trials is necessary to inform the development of medical treatments and interventions that can translate into effective use in diverse populations and address health inequalities.5,6 Prior research suggests that clinical trial knowledge may play a key role in clinical trial participation and help to address longstanding disparities in clinical trial participation.7,8 Recent studies show that clinical trial knowledge is low globally. A survey of 12,427 individuals across 68 countries in 2017 found that more than half of participants were unsure about where clinical trials were conducted.9 The COVID-19 pandemic provided a key opportunity to educate the public about clinical trials, given the numerous ongoing trials to support vaccine and treatment development.10 A few studies have started to explore clinical trial knowledge during the COVID-19 pandemic.1,11,12 However, there has been limited study nationally to assess clinical trial knowledge or trusted sources of information for clinical trials. [...]it is timely to assess clinical trial knowledge among a representative sample of US adults. Demographics and other covariates Respondents' age In years (18-49, 50-64 or 65+), sex (men or women), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic or other), education (less than high school, high school graduate, some college, college or higher), marital status (married, divorced/widowed/separated or single), annual family Income (less than $20,000, $20,000 to <$35,000, $35,000 to <$50,000, $50,000 to <$75,000 or $75,000+), employment (employed or not employed), census region (northeast, midwest, south, west), health Insurance (yes or no), general health (excellent, very good, good, fair or poor), chronic conditions (hypertension, diabetes, heart disease, lung disease or cancer) and number of visits to provider (0, 1-2, 3-4 or 5+) were Included as covariates. Due to the small sample size and missing responses, multivariable models to examine Information sources and motives of clinical trial participation were not Included. [...]we only report the bivariate associations between the level of clinical trial knowledge, Information source and clinical trial participation motives.

6.
Front Public Health ; 10: 962862, 2022.
Article in English | MEDLINE | ID: covidwho-2065647

ABSTRACT

Background: Latinx communities are disproportionately affected by COVID-19 compared with non-Latinx White communities in Oregon and much of the United States. The COVID-19 pandemic presents a critical and urgent need to reach Latinx communities with innovative, culturally tailored outreach and health promotion interventions to reduce viral transmission and address disparities. The aims of this case study are to (1) outline the collaborative development of a culturally and trauma-informed COVID-19 preventive intervention for Latinx communities; (2) describe essential intervention elements; and (3) summarize strengths and lessons learned for future applications. Methods: Between June 2020 and January 2021, a multidisciplinary team of researchers and Latinx-serving partners engaged in the following intervention development activities: a scientific literature review, a survey of 67 Latinx residents attending public testing events, interviews with 13 leaders of community-based organizations serving Latinx residents, and bi-weekly consultations with the project's Public Health and Community Services Team and a regional Community and Scientific Advisory Board. After launching the intervention in the field in February 2021, bi-weekly meetings with interventionists continuously informed minor iterative refinements through present day. Results: The resulting intervention, Promotores de Salud, includes outreach and brief health education. Bilingual, trauma-informed trainings and materials reflect the lived experiences, cultural values, needs, and concerns of Latinx communities. Interventionists (21 Promotores) were Latinx residents from nine Oregon counties where the intervention was delivered. Conclusions: Sharing development and intervention details with public health researchers and practitioners facilitates intervention uptake and replication to optimize the public health effect in Oregon's Latinx communities and beyond.


Subject(s)
COVID-19 , COVID-19/prevention & control , Health Promotion , Hispanic or Latino , Humans , Oregon , Pandemics , United States
7.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

8.
American Journal of Transplantation ; 22(Supplement 3):943, 2022.
Article in English | EMBASE | ID: covidwho-2063537

ABSTRACT

Purpose: To evaluate the efficacy and safety of a protocol increasing the net state of immunosuppression for adult kidney transplant recipients (KTR) with delayed graft function (DGF). Method(s): Single-center retrospective cohort of adult KTR with DGF transplanted from January 2017 to March 2021. Pre- vs post-DGF protocol implementation outcomes were evaluated. Protocol included cumulative 6 mg/kg rabbit antithymocyte globulin (rATG) induction, non-weight-based mycophenolate mofetil dosing (1000 mg bid), and higher goal tacrolimus trough (9-12 ng/mL). Pre-protocol patients received cumulative 4.5 mg/kg rATG. Efficacy outcomes were biopsy proven acute rejection (BPAR) and graft loss at 6 months. Safety outcomes were incidence of cytopenia, infection, and all-cause readmission at 6 months. Result(s): Eighty-nine DGF patients met inclusion criteria. Baseline characteristics were similar between groups, with median age (57+/-19) years and majority Hispanic (42.7%) males (61.8%) with a negative crossmatch (100%). Most post-protocol patients received 6 mg/kg cumulative rATG induction (71.4%) and mycophenolate mofetil 1,000 mg bid (80.3%) with therapeutic tacrolimus troughs by discharge (64.3%). Significantly less BPAR was observed post-protocol (7/56, 12.5% vs 10/33, 30.3%;p = 0.04). Of those with BPAR, significantly less post-protocol patients experienced T-cell mediated rejection (TCMR) than pre-protocol (2/7, 28.6% vs 9/10, 90.0%;p = 0.03). However, antibody-mediated (4/7, 57.1% vs 1/10, 10%) and mixed (1/7, 14.3% vs 0%) rejection were more frequent post-protocol (p = 0.10 and 0.41, respectively). Graft loss was similar post- vs pre-protocol (5/56, 8.9% vs 0;p = 0.16). All post-protocol graft losses were due to death (4 from COVID-19 and 1 unknown). Safety outcomes were similar between groups (Table 1). Conclusion(s): An increased net state of immunosuppression in DGF KTR significantly lowered the 6-month incidence of BPAR without significantly affecting safety. TCMR incidence was significantly decreased, but displaced by antibody-mediated and mixed rejection, implying need to conduct further prospective studies of larger sample sizes. Given majority of graft losses were due to COVID-19 pneumonia, studies are needed to evaluate the risk of COVID-19 infections in DGF KTR, especially with the availability of vaccines. (Table Presented).

9.
American Journal of Transplantation ; 22(Supplement 3):1073, 2022.
Article in English | EMBASE | ID: covidwho-2063509

ABSTRACT

Purpose: The purpose of this study was to assess treatment of coronavirus disease 2019 (COVID-19) and immunosuppression modification in solid organ transplant (SOT) recipients, and identify risk factors that contribute to mortality among SOT recipients with COVID-19. Method(s): The primary endpoint was 90-day mortality. Secondary endpoints include COVID-19 treatment regimen, laboratory abnormalities, maintenance immunosuppression modification, concomitant infections, complications such as renal replacement therapy (RRT) and more. This retrospective chart review included all SOT recipients who presented to our institution with a positive COVID-19 test over an 18-month period. Dual organ transplant recipients were excluded. Result(s): A total of 112 patients met inclusion criteria. The average age was 56 +/- 13 years and 58% of patients were male. The majority of patients identified as Latino (39%), followed by African-American (29%) and Caucasian (28%). Forty-nine percent required treatment in the intensive care unit. Inflammatory markers were elevated in the majority of patients. Most immunosuppression modification strategies held antimetabolites and prednisone if receiving treatment with glucocorticoids. The primary endpoint of 90-day mortality was observed in 24% (27/112) of patients. Mortality rates by organ type can be found in Table 1. Common comorbidities in these patients are depicted in Figure 1. There was no significant difference in mortality between patients receiving remdesivir 12/27 vs. 20/85 (p=0.05). A 50% (4/8) mortality rate was observed among patients who received rabbit antithymocyte globulin within 6 months of COVID-19 infection (p=0.09). Concomitant respiratory infections showed a statistically significant difference in mortality 12/27 vs. 9/85 (p<0.05). All 6 patients that required extracorporeal membrane oxygenation expired. Fifty-two percent (14/27) of patients in the mortality group required RRT vs. 7% (6/85) of those that survived (p<0.05). While most cases were prior to the advent of COVID-19 vaccines, all 9 patients that received at least one dose of any COVID-19 vaccine prior to infection survived at 90 days. Conclusion(s): Concomitant respiratory infections and RRT were significant predictors of mortality among SOT recipients with COVID-19. Administration of rabbit antithymocyte globulin within 6 months of COVID-19 infection and treatment with remdesivir should be investigated in future studies as they may demonstrate significant associations in a larger sample size.

10.
American Journal of Transplantation ; 22(Supplement 3):639, 2022.
Article in English | EMBASE | ID: covidwho-2063507

ABSTRACT

Purpose: Despite the large numbers of reports on patient risk factors for poor clinical outcomes with COVID-19, little is known about how these risks may differ for solid organ transplant (SOT) recipients versus non-SOT (NSOT) patients. Method(s): We reviewed demographic and comorbid conditions in a cohort of SOT (n=129) and NSOT patients (n=708) admitted to our center for COVID-19 between December 2019 and February 2021. Patient characteristics were compared between groups using the t-test or chi-square test. Univariable and multivariable (stepwise reduced) logistic regression models were constructed for our outcomes of interest. Result(s): Patient age and sex were similar between SOT and NSOT cohorts. However, SOT patients were more likely to be of Hispanic ethnicity (64% v. 39%, p<0.001). Both SOT and NSOT had similar incidence of neurologic conditions (23% and 21%, p=0.476), but SOT patients were more likely to have comorbid conditions including diabetes mellitus, cardiovascular condition, or lung disease (all p<0.001). Several clinical factors were associated with ICU admission in NSOT patients, including patient age, diabetes, cardiac disease, neurologic disease, obesity, and hepatobiliary disease (all p < 0.05). In contrast, only cardiac disease was associated with ICU admission for SOT patients (p=0.010). Multivariable analysis of factors associated with increased mortality revealed that neurologic condition (OR 3.0, 95% CI 0.8-11.4) and lung disease (OR 3.5, 95% CI 0.7-18.2) were significant for SOT patients in a model including age, sex, and other comorbid conditions. In contrast, for NSOT patients, history of a neurologic condition (OR 2.3, 95% CI 1.3-4.0) and age >65 (OR 4.2, 95% CI 2.1-8.7) were significantly associated with death in a multivariate analysis. Conclusion(s): It has been previously unclear whether risk factors associated with poor outcomes in NSOT patients with COVID-19 will be similarly important in SOT recipients. Our analysis demonstrated different risk associations in contemporaneous patient cohorts at a single academic center. This observation suggests that SOT-specific approaches for risk stratification would be beneficial for patient evaluation and triage.

11.
American Journal of Transplantation ; 22(Supplement 3):765, 2022.
Article in English | EMBASE | ID: covidwho-2063490

ABSTRACT

Purpose: The purpose of the study was to examine the clinical course, outcomes, and complications of COVID-19 in pediatric solid organ transplant patients from a single institution, with special attention to thrombotic complications, multiple inflammatory syndrome in children (MIS-C), and new rejection. Method(s): The medical record at our institution was retrospectively queried for all solid organ transplant patients up to 21 years old diagnosed with COVID-19 from March 2020 to September 2021. This cohort was compared in a 1:1 fashion with age, sex, and ethnicity-matched controls with COVID-19 infection, but no history of transplant. Categorical variables were analyzed with Chi-square or Fisher's exact test, and continuous variables were analyzed with Mann-Whitney test. Result(s): 44 solid organ transplant patients met study inclusion criteria. Six patients were excluded from analysis due to insufficient documentation of COVID-19 diagnosis or course. The cohort was composed of 17 kidney, 11 heart, six liver, two lung, one liver-kidney, and one multivisceral transplant patients. Median age at COVID-19 diagnosis was 15 years (IQR 9). Median time from transplant to COVID-19 diagnosis was 2.5 years (IQR 3.4). Of the 38 patients, 17 were white non-Hispanic/Latino (44.7%), 12 were Hispanic/Latino (31.6%), three were Black (7.9%), two were Asian (5.3%), three were other (7.9%), and one was unknown (2.6%). 19 patients (50%) were male. 12 transplant patients were asymptomatic (31.6%), compared to five controls (13.2%, p=0.054). Of the symptomatic patients, the most common symptoms in the solid organ transplant group were fever (26.3%) and headache (18.4%), with few patients experiencing shortness of breath (5.3%). Hospital (15.8%) and ICU (5.3%) admission rates were equal in both groups, with a median length of stay of 4.5 days for the transplant group (IQR 5.25) versus 4 days (IQR 5.75) for controls (p=0.59). 32 patients in each group received supportive care as outpatients (84.2%). A minority of transplant patients received monoclonal antibody (6.3%), convalescent plasma (6.3%), steroids (6.3%), and remdesivir (3.1%). There was one case of MIS-C in the transplant group (2.6%) versus three in the control group (7.9%) (p=0.62). One transplant patient developed COVID-associated microangiopathy (2.6%), but there were no thrombotic complications among controls (p > 0.99). There were no new cases of cellular or antibody-mediated rejection following COVID-19. There was one death in the transplant cohort, but no deaths in the control group. Conclusion(s): We report the largest multi-organ cohort of pediatric solid organ transplant recipients with COVID-19 to date. Our findings suggest pediatric solid organ transplant patients fare similarly to healthy children, without elevated risk of complications.

12.
American Journal of Transplantation ; 22(Supplement 3):863-864, 2022.
Article in English | EMBASE | ID: covidwho-2063472

ABSTRACT

Purpose: Despite several policy reforms over the years, disparities in the access to solid organ transplantation continues to exist remains a significant barrier to liver transplant. The MELD Allocation system and subsequently the Share-35 policy (adopted June 2013) were implemented to address the inequitable access to liver transplantation (LT). The implication of these changes on adult and pediatric LT among ethnic groups is uncertain. Therefore the aim of this study, is to explore the factors associated with access to LT across ethnic groups of all age groups. Method(s): The study period (2014 -2019) included the period after Share-35 policy (June 2013) implementation and prior to implantation of Acuity Circle and COVID pandemic (Feb/March 2020). Using the UNOS database, we identified all candidates (Pediatrics and Adults), who received liver Transplant during the study period. Data extracted included type of transplant, liver diagnosis, age, MELD/PELD score, gender and race/ethnicity. Chi square test and anova were used for comparative analysis. Result(s): During the study period, 46,926 candidates received liver transplant of which 96% were Adults, living donor LT (5%) and ethnic distribution (White 69%, Hispanic 15%, Black 9%, Asian 4% and others 3%). In contrast to the Adult recipients in which there is a gender variation with male predominance (65%), among pediatric group there was similar distribution (Male 51% and Female 49%). There was significant ethnic variation in type of insurance payor (Figure 1) and proportion of LT (Figure 2) across age groups. Among pediatric recipients, no significant difference in LT trends across ethnic groups. In contrary, among the adult recipients, though there was no change among White (71% in 2014 and 71% in 2019) and Asian (4% in 2014 and 4% in 2019), there was slight increase among Hispanic ( 13 % in 2014 and 16% in 2019) and a steady decline among Blacks ( 10% in 2014 and 7.3% in 2019). Conclusion(s): Ethnic Variation in Access to Liver Transplantation exists in both Adult and Pediatric Candidates. Future studies to explore the observed difference in Insurance payors, gender gaps among ethnic groups will provide useful insights to the non-medical factors contributing to inequitable LT access irrespective of age. Identification and understanding the key social determinants that impact LT access will be key in developing strategies to reduce and eliminate these barriers across age groups.

13.
American Journal of Transplantation ; 22(Supplement 3):1046, 2022.
Article in English | EMBASE | ID: covidwho-2063452

ABSTRACT

Purpose: Little is known about patient-reported factors affecting patients' access to the kidney transplant waitlist after starting evaluation. We qualitatively assessed patients' perceived barriers to completing kidney transplant evaluation. Method(s): We conducted semi-structured telephone interviews with patients undergoing kidney transplant evaluation at 1 transplant program. Transcripts were analyzed by thematic analysis. Result(s): 26 patients participated (26% participation rate), identifying as Black (46%), White (39%), or Hispanic (15%), who underwent evaluation for a mean (SD) of 12 (23) months [range: 1-120]. Critical barriers to completing transplant evaluation reported based on experiences at prior transplant programs and/or the current program were poor communication with the transplant team, negative interactions with the transplant team, and difficulties scheduling transplant tests. Due to inconsistent and unclear communication with the transplant team, patients reported they had "[no] clue about what's going on." The lack of follow-up from the team contributed to patients feeling a loss of control over their health. Patients did not know their waitlist status or what medical exams they needed to complete and reported repeated attempts to contact the team for information. Patients perceived the transplant team as "cold" and "uncaring" and reported feeling as if "nobody gives a damn about [them]." Seven (27%) patients reported that structural racism affected their transplant evaluation process. Transplant team interactions made Black patients feel less than human. One patient perceived that the team thought their transplant did not matter because "Black people don't usually do what they are supposed to do" compared to White patients. Black patients perceived the transplant evaluation process as "tough" for Black individuals, emphasizing the importance of having a transplant team who have "some cultural background in dealing with" minoritized patients. Black patients reported feeling as if the transplant team feared them and reported experiencing unfair treatment due to their race, prompting them to seek treatment elsewhere. Overall, patients reported difficulties scheduling and completing medical exams due to conflicts with their work and dialysis schedules. Patients experienced challenges with identifying hospitals that provided required clinical exams during the Covid-19 pandemic. Conclusion(s): Preliminary findings suggest that communication and structural barriers impede progression through the transplant evaluation process. Interventions are needed to redress these barriers. Further analysis will assess whether racial/ ethnic minorities experience barriers differently as a source of disparities in access to the transplant waitlist.

14.
American Journal of Transplantation ; 22(Supplement 3):1111, 2022.
Article in English | EMBASE | ID: covidwho-2063438

ABSTRACT

Purpose: During the COVID-19 pandemic, kidney transplant (KT) evaluations shifted from in-person evaluation (IPE) to telemedicine evaluation (TME). Given differences in access to electronics and internet, we thought that TME may advantage some social groups' access to the KT list. We evaluated if differences in acceptance to KT listing exist between pre- and post-pandemic eras, or between IPE and TME. We identified associations between other socioeconomic factors and KT listing. Method(s): Demographic and social data were collected from charts of patients evaluated for KT in the pre- (3/13/2019-3/13/2020) and post-pandemic era (3/14/2020- 3/14/2021). Categorical data are presented in proportions and frequencies;continuous data in means+/-SDEV. Independent group t-tests and Fisher's exact tests were used for bivariate comparisons. Result(s): Of 1061 charts, 1015 included data on race/ethnicity: 608 (59.1%) Black, 335 (33.6%) White, 40 (3.9%) Hispanic, 29 (2.8%) Asian, and 3 (0.3%) other. Overall, 629 (59%) evaluations were pre- and 430 (41%) post-pandemic. 734 (72%) were IPE and 288 (28%) TME. 553 (54%) candidates were denied for medical (310, 56%) and social (184, 33%) reasons;469 (46%) were accepted for listing. Employment status was known in 979 candidates: 278 (28%) employed, 368 (38%) disabled, 66 (7%) unemployed, and 267 (27%) retired. Evaluation in the post-pandemic era (p=0.002) was associated with acceptance for listing. TME was also associated with acceptance for listing (p<0.001). Pre-pandemic, there were 604 IPE and 1 TME of whom 253 (42%) were accepted, including the TME (p=0.238). Post-pandemic 130 evaluations were IPE and 287 TME, of whom 215 (52%) were accepted, including 58 (45%) IPE and 157 (55%) TME (p=0.061). Employment status (p<0.001) and mental health status (p=0.009) were associated with acceptance for listing. There was no association between race/ethnicity (p=0.809) or distance from home to the transplant center (p=0.693) and acceptance for listing. There were no differences in race/ ethnicity (p=0.951), employment status (p=0.202), or mental health status (p=0.742) between pre- and post-pandemic eras. Assessment of social support (p=0.002) and overall social work assessment (p<0.001) were associated with acceptance for listing. The level of social support (rated on a 1-5 scale) was associated with being accepted for listing pre-pandemic (p=0.001) but not post-pandemic (p=0.769). Conclusion(s): KT evaluations decreased by about one third during the post-pandemic era. Evaluation in the post-pandemic era, evaluation by TME, employment status, mental health status, assessment of social support and overall social work assessment were all associated with being listed for KT. There were no differences in race/ethnicity, employment status, or mental health status between eras, which is unexpected given the additional stressors of the pandemic on employment and mental health.

15.
American Journal of Transplantation ; 22(Supplement 3):872, 2022.
Article in English | EMBASE | ID: covidwho-2063428

ABSTRACT

Purpose: Health disparities in the United States (U.S.) have become more evident during the pandemic with disproportionate death rates in Blacks and Hispanics (with and without COVID-19). The purpose of this study was to examine U.S. data for rates of change in deceased organ donation and transplantation during a global pandemic. Method(s): We conducted a retrospective analysis of U. S. aggregated data from the Organ Procurement and Transplantation Network (OPTN) from January 2019 to December 2021. The data collected included organ donation, transplantation, and UNOS regions. We calculated the annual percentage change for Whites, Blacks, and Hispanics during the pandemic (2020-2021). Result(s): The overall annual rate of change in deceased donor organ donation increased by 6% in 2020 and 10% in 2021. However, ethnic minorities experienced a combined 14% increase in 2020 deceased organ donation (10% Black and 4% Hispanic), but a combined 1% decrease in 2021 (-3% Blacks and 2% Hispanics). The overall annual rate of change in deceased donor organ transplantation increased by 3% in 2020 and 5% in 2021. However, Black and Hispanic recipients experienced a collective 6% increase in deceased organ transplantation in 2020 (5% Blacks and 1% Hispanics) and a summative 17% increase in 2021 (8% Blacks and 11% Hispanics). Regional variation was also observed across ethnic groups. Conclusion(s): Overarching cultural disparities affect organ donation and transplantation;thus, it is imperative to examine the relative annual changes by ethnicity alongside overall changes. COVID and non-COVID excessive death rates in people of color during the pandemic played a role in potential candidates for organ donation and transplantation. In 2020, when excessive minority deaths were attributed to COVID-19 by the CDC, the rate of minority deceased organ donation increased by 14% (10% Blacks and 4% Hispanics). During this same timeframe, the rate of transplants increased in Black (5%) and Hispanic (1%) recipients. Since the implementation of widespread vaccination distribution, community education for vaccination hesitancy, and access to more aggressive treatment and testing options, these trends in minority organ donation have not persisted. Exactly how this translates into long-term disparities in end-organ failure, organ donation, and transplantation has yet to be determined. (Figure Presented).

16.
American Journal of Transplantation ; 22(Supplement 3):929-930, 2022.
Article in English | EMBASE | ID: covidwho-2063417

ABSTRACT

Purpose: The risk of severe COVID-19 requiring hospitalization and death is higher in solid organ transplant recipients (SOTr). There remains limited data on the use of monoclonal antibodies and long-term outcomes in SOTr. Method(s): This is a retrospective study conducted at Jackson Health System-Miami Transplant Institute in SOTr with mild-moderate COVID-19, from November 2020 to October 2021. Bamlanivimab was used initially for outpatients with mild to moderate COVID-19 but switched to casirivimab/imdevimab on March 1, 2021, due to rising prevalence of SARS-CoV-2 variants in the Miami-Dade area. Outcomes assessed included emergency department visits, hospitalizations, allograft rejection, and death. Result(s): Ninety-two patients were treated, most commonly with casirivimab/imdevimab (74%). The median age was 51 (range, 18-81) years, with 61% male and 60% Hispanic ethnicity. Transplanted organs included 68 kidney (74%), 10 liver (10.8%), 10 heart (10.8%), and 7 lung (7.6 %). Forty-two (45.6%) had a vaccine breakthrough infection, of which 34 (80.9%) were during the delta variant predominance. The median time from positive SARS-CoV-2 test to administration of monoclonal antibody was 1 (range, 0 - 10) day. Anti-metabolite agents were decreased or held in 54.3% of cases. Median follow-up was 116 (range, 19 - 358) days. Five (5.8%) patients had an emergency department visit, 26 (28.2%) were hospitalized;of which 11 (42%) were due to worsening COVID-19 symptoms within 28-days of infusion. 63.6% (7/11) required supplemental oxygen, none required mechanical ventilation. The median hospital length of stay was 6 (range, 2-32) days and all patients were discharged alive. During follow-up, 6 (4 kidney, 2 heart;6.5%) developed biopsy proven rejection. No graft loss or death occurred in this cohort. Conclusion(s): Early use of monoclonal antibodies in SOTr is associated with favorable outcomes. Multi-center studies assessing use of monoclonal antibodies in breakthrough infections and association with allograft rejection are needed.

17.
American Journal of Transplantation ; 22(Supplement 3):1033, 2022.
Article in English | EMBASE | ID: covidwho-2063415

ABSTRACT

Purpose: COVID-19 poses a disproportionate threat to renal transplant recipients (RTR), who are chronically immunosuppressed. Studies have indicated a 16% mortality rate compared to <5% for the general population. Effective vaccines (Pfizer, Moderna and, Johnson & Johnson) provided hope for protection against severe COVID-19 in this at-risk population. However, based on experience with vaccines against other viral infections, two primary concerns arose: 1) would the SARS-CoV-2 vaccines be effective in this population;2) could these vaccines provoke rejection? Methods: To address these questions, we tested serum creatinine, anti-SARS-CoV-2 S antibody (Roche ElecsysR), Donor Specific anti HLA Antibodies, other antibodies against SARS-CoV-2, other coronaviruses (LABScreenTMCOVID Plus, One Lambda), and donor derived cell free DNA (dd-cfDNA;fraction, absolute and total quantity, using the ProsperaTM Test, Natera, Inc.) in RTR at the time of vaccine doses 1 and 2 and 1, 3, and 6 months after the second dose. dd-cfDNA >=1% and 78 cp/ mL indicated an increased risk of rejection. 53 patients were consented and enrolled in the study. This study received IRB approval. Statistical analysis was performed using paired two-tailed student's t-test. Result(s): This preliminary analysis analyzed the impact of vaccination on dd-cfDNA levels in 31 RTR patients. This cohort was primarily female (67%) and of hispanic descent (48.3%) with a median age 55 years (range: 19-81). All but 1 patient received the Pfizer vaccination series. Mean time from transplant to vaccination 1 was 114.6 months (range: 10-359 months). Between vaccination 1 and 2, no patients had clinical suspicion of rejection, were hospitalized or underwent for-cause biopsy. No significant differences in dd-cfDNA or total cf-DNA levels were found by Prospera testing between vaccination 1 and 2. (Table 1). Between vaccination 1 and 2, one patient had an increase dd-cfDNA% above the normal range (0.14%, 2.37%), but absolute dd-cfDNA quantity remained in normal range (13.70 cp/mL, 66.08 cp/ mL). At the time of the vaccination 1, dd-cfDNA% was elevated in 2 patients. At vaccination 2, dd-cfDNA% had returned to the normal range for one patient (ddcfDNA quantity was normal for both vaccinations), while both dd-cfDNA% and quantity remained elevated in the other. Conclusion(s): Based on measurement of dd-cfDNA fraction, absolute quantity and total quantity with the Prospera test at vaccination 1 and 2, there was no evidence of SARS-CoV-2 vaccination-induced rejection.

18.
American Journal of Transplantation ; 22(Supplement 3):775, 2022.
Article in English | EMBASE | ID: covidwho-2063408

ABSTRACT

Purpose: We aimed to investigate the mortality from SARS-CoV-2 in kidney transplant recipients in the Bronx, New York since the beginning of the pandemic Methods: Between March 16, 2020 and November 5, 2021, 453 patients were diagnosed with SARS-CoV-2 infection. 316 were diagnosed by RT-PCR while the remaining 137 tested positive for anti-SARS-CoV-2 nucleocapsid IgG and did not have significant symptoms and had not been previously tested by RT-PCR Results: Of the 316 patients diagnosed by RT-PCR, 214 patients were hospitalized while 102 patients were managed at home as outpatient. 194 (61.3%) were male, median age 61 years old (IQR: 48-69), predominantly Hispanic (56.2%) and African American (29.5%). 75% received a deceased-donor renal transplant, 58% received anti-thymocyte induction. Most patients were on triple immunosuppression (95% on calcineurin inhibitors, 87% on anti-metabolite, and 97% on prednisone). Hypertension was the most common comorbidity followed by diabetes mellitus, heart disease and lung disease. A total of 65 patients (20.5%) died. The mortality rate was 37 % (47/128) in patients diagnosed between March 16 and April 30, 2020. From May 1, 2020 to end of December 2020 mortality rate has significantly decreased to 11% (7/61). Since the beginning of 2021 till November 5, 2021 the mortality rate is 7.7% (10/129). Twenty-seven patients were diagnosed with COVID-19 despite being partially of fully vaccinated (25 fully vaccinated, 2 after one dose of vaccine). 13/27 (48%) were managed at home while 14/27 (52%) were hospitalized and 2 (7%) of them died. Twenty-eight patients received treatment with casirivimab and imdevimab post diagnosis of SARS-CoV-2 starting 2021 and none of those patients have died. Conclusion(s): In summary, mortality from SARS-CoV-2 infection in kidney transplant recipients was higher earlier at the pandemic and has significantly decreased over time. This could be explained by initial exposure of the patients with higher viral load due to lack of personal protection and social distancing. However, since the judicious use of monoclonal antibodies and vaccination, in addition to social distancing protocols and use of facemask, the mortality in kidney transplant recipients has decreased over time.

19.
American Journal of Transplantation ; 22(Supplement 3):528, 2022.
Article in English | EMBASE | ID: covidwho-2063394

ABSTRACT

Purpose: Alcohol use after liver transplant is associated with higher rates of graft loss and increased mortality;however, there is limited data regarding the factors that influence biochemically confirmed relapse. We aimed to evaluate the association between social determinants of health (SDOH) and biochemical alcohol relapse in patients who have been transplanted for alcohol-associated liver disease (ALD). Method(s): This single-center, retrospective cohort study examined patients with ALD who were transplanted between 2018-2021. The primary outcome was biochemical alcohol relapse as measured by systematic phosphatidylethanol (PEth) testing. SDOH including race, ethnicity, income, employment, social support, education level, public vs private health insurance, mental health comorbidities, and comorbid illicit substance use were assessed for their association with the outcome using logistic regression analyses. Additionally, temporal trends in biochemical relapse related to the Covid-19 pandemic were evaluated using a cut point of April 2020 to differentiate between pre-pandemic and pandemic groups. Result(s): Seventy-five patients were transplanted for ALD over the study period, of whom 71 had biochemical PEth measurements (95%). Of these 71 patients, 21% were female with a mean (+/-SD) age of 52.9 (+/-10.4) years and 49% of the study population identified as Hispanic ethnicity. At the time of transplant listing, 73% were unemployed, 65% had public insurance, and 62% were married or had a stable co-companion. Over 64 person-years of follow up, 10 (15%) patients had biochemical relapse after transplant. Older age was protective OR=0.94 (95% CI 0.88-0.99;p=0.05), while non-Hispanic white race OR=6.29 (95% CI 1.22-32.51;p=0.03), and prior illicit substance use OR=4.2 (95% CI 1.05-16.90;p=0.04) were associated with an increased risk of relapse. Patients identifying as non-Hispanic white had non-significant trends toward lower household income, decreased social support, and higher rates of comorbid mental illness. Severe acute alcohol hepatitis, time from last drink to listing, SIPAT and AUDIT score were not associated with increased risk of relapse. The risk of relapse increased during the Covid-19 pandemic from 4.3% pre-Covid-19 to 18.8% during Covid-19 with a trend towards statistical significance OR=5.1 (95% CI 0.60-42.8;p=0.13). Conclusion(s): Non-Hispanic white race, younger age, and illicit substance use were associated with increased rates of biochemical alcohol relapse and may be explained by SDOH;however, conventional metrics including >6 months from last drink to listing and lower SIPAT score were not predictive of biochemical relapse.

20.
American Journal of Transplantation ; 22(Supplement 3):348, 2022.
Article in English | EMBASE | ID: covidwho-2063374

ABSTRACT

Purpose: Lung transplant may be a viable treatment option for select patients with non-recoverable COVID-19-associated acute respiratory distress syndrome (ARDS) and COVID-19-associated pulmonary fibrosis. This study aims to characterize the utilization and outcomes of lung transplant among patients with COVID-19- associated ARDS and pulmonary fibrosis. Method(s): We analyzed the Organ Procurement Transplant Network database to characterize the prevalence and characteristics of patients with COVID-19-associated ARDS and pulmonary fibrosis who were added to the waiting list and/or received a lung transplant between March 13, 2020 and July 31, 2021. Result(s): We found that 207 lung candidate registrations were added to the waiting list and 182 lung transplants were conducted for patients with COVID-19-associated ARDS or pulmonary fibrosis. The majority of lung candidates and lung transplant recipients with COVID-19-associated diagnoses were male, had private insurance, were disproportionately Hispanic and had a higher lung allocation scores (LAS) compared to patients with non-COVID-19 diagnoses. There was no significant difference in 30-day post-transplant survival among recipients with COVID-19- associated diagnoses compared to non-COVID-19 diagnoses. Conclusion(s): Future research on post-transplant outcomes among lung transplant recipients with COVID-19-associated diagnoses is warranted. Further study of outcomes may assist in refining the appropriate LAS waitlist mortality and posttransplant survival scoring for these patients. (Figure Presented).

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