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1.
Gastroenterology ; 162(7):S-1196-S-1197, 2022.
Article in English | EMBASE | ID: covidwho-1967422

ABSTRACT

Background: The increasing number of deceased drug overdose donors (DOD) has paralleled the recent rise in the opioid epidemic, which has been further exacerbated by the COVID- 19 pandemic. While the transplant community has seen a rise in allografts donated by victims of drug overdose, we aim to characterize the recent shifts in DOD utilization during the pre-COVID and COVID eras. Methods: Using the United Network for Organ Sharing (UNOS) registry, we analyzed all adult recipients that underwent solid organ transplantation (SOT) including liver transplant (LT) in the United States from January 1, 2017 through June 30, 2021. The pre-COVID era was defined from January 1, 2019 to February 29, 2020 and the COVID era was defined from May 1, 2020 to June 30, 2021 (14 months each). We excluded March and April 2020 because transplant volume was adversely affected due to diversion of resources. DOD were identified using the UNOS variable that characterizes the mechanism of death of the donor. Tests of proportions and unpaired T-tests were performed to compare demographic information and clinical characteristics of DOD from the pre-COVID and COVID eras. Results: The number of donors for all SOT remained stable in the pre-COVID and COVID eras (14,029 vs 15,547). Likewise, the number of LTs remained stable (9,687 vs 10,096), reflected by a rise in DOD utilization. From the pre- COVID to the COVID eras, the utilization of DOD for SOT increased by 33% from 13.7% (n=1924) to 16.4% (n=2553) as shown in Table 1. This increase in DOD utilization during the pandemic was seen across all organ types with a significant rise for LT (pre-COVID n= 1465, 15.1% vs COVID n=1846, 18.3%;P<0.001). Among DOD, the percentage of young adult donors < 30 declined (31.2% vs 28.0%;P=0.022) in the COVID era. Similarly, the percentage of DOD with HCV seropositivity and HCV viremia decreased by 5.2% (34.3% vs 29.1%;P<0.001) and 4.3% (22.1% vs 17.8%;P<0.001) respectively. Regionally, there was a significant increase in DOD utilization in the South and Midwest (Table 1). Conclusion: The continued rise in the opioid epidemic has led to increased utilization of otherwise healthy DOD. This increase in DOD utilization has contributed to the steady transplant volume during the pandemic for all organ types, including LT. Fewer DOD with HCV during the pandemic reflects recent national trends. Unlike the early phases of the opioid epidemic, there is less of a regional distribution of utilization of allografts from DOD. (Table Presented)

2.
Orv Hetil ; 163(30): 1181-1188, 2022 Jul 24.
Article in English | MEDLINE | ID: covidwho-1963094

ABSTRACT

INTRODUCTION: The incidence of organ transplantation between the Eastern and Western part of Europe is quite different. This has several reasons; the main cause may be the Great Schism (A. D. 1054) when the Byzantine Empire separated himself also religiously from Rome. Since then there has been a different historical development followable until our days. Later on, disintegration of four previous large empires into many smaller countries during the last 150 years, furthermore in the second half of the twentieth century the separation by the Iron Curtain in the middle of Europe led to different social-economic and infrastructural developments between the different parts of the continent. In the new millennium, all transplantations for the routinely performed 5 organs were available for the Hungarian patients, but the real era-changing happened in 2012/13 by joining Eurotransplant. OBJECTIVE: Our analysis is based on the transplantation numbers of the last pre-COVID pandemic year (2019). RESULTS: The abovementioned differences can be traced well by the transplantation numbers: 28 Western- and Middle-European countries have 22.2 cadaveric donors per million population versus 3.8 for 10 Eastern-European countries and another 7 do not have any. The numbers of transplanted organs are the following: 39.5 vs. 12.0 for kidney; 14.8 vs. 5.5 for liver; 5.4 vs. 0.8 for heart; 4.6 vs. 0.2 for lung. DISCUSSION: The statistics have also a rejoicing message because since the fall of the Iron Curtain, 10 Middle-European countries could reach the Western standards in organ transplantation. Their example is also good news for other Eastern European countries. CONCLUSION: Hungary was one of these countries who could benefit from the political changes and, by joining Eurotransplant, the quantity and quality of the transplanted organs was raised significantly: since then, there are by 40% more transplantations performed in our country. Orv Hetil. 2022; 163(30): 1181-1188.


Subject(s)
COVID-19 , Organ Transplantation , Tissue and Organ Procurement , Humans , Hungary , Tissue Donors
3.
Camb Q Healthc Ethics ; 31(3): 368-378, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1960188

ABSTRACT

Organ trafficking in all its various forms is an international crime which could be entirely eliminated if healthcare professionals refused to participate in or be complicit with it. Types of organ trafficking are defined and principal international declarations and resolutions concerning it are discussed. The evidence for the involvement of healthcare professionals is illustrated with examples from South Africa and China. The ways in which healthcare professionals directly or indirectly perpetuate illegal organ transplantation are then considered, including lack of awareness, the paucity of both undergraduate and postgraduate education on organ trafficking, turning a blind eye, advocacy of organ commercialism, and the lure of financial gain.


Subject(s)
Organ Trafficking , Organ Transplantation , Tissue and Organ Procurement , China , Crime , Health Personnel , Humans
4.
Journal of the Peripheral Nervous System ; 27, 2022.
Article in English | EMBASE | ID: covidwho-1935098

ABSTRACT

The proceedings contain 69 papers. The topics discussed include: chemotherapy induced peripheral neurotoxicy: why should we care?;studying the caudal nerve anatomy and physiology to refine detection of peripheral nerve damage in rodent models;anxiety and depression in Charcot-Marie-tooth disease: data from the Italian CMT National Registry;fatigue in CMT: a web based survey from the Italian CMT National Registry;early molecular diagnosis of mutations on the transthyretin gene as a strategy to improve the prognosis of hereditary transthyretin-mediated amyloidosis - an update of the GENILAM project;THR124MET myelin protein zero mutation mimicking motor neuron disease;torsional neuropathy in parsonage turner syndrome following anti-COVID19 vaccination. how to detect and manage with it?;isolated musculocutaneous involvement in parsonage-turner syndrome associated with SARS-COV2 vaccination;neonatal FC receptor expression in patients with chronic dysimmune neuropathy. a feasibility study;and peripheral neuropathies after common organ transplantations. literature review and the use of electrophysiological tests and ultrasound.

5.
Transpl Infect Dis ; 24(4): e13901, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1937994

ABSTRACT

BACKGROUND: Solid organ transplant recipients (SOTRs) are at high-risk for severe infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Anti-spike monoclonal antibodies are currently utilized under emergency use authorization to prevent hospitalization in high-risk individuals with coronavirus disease 2019 (COVID-19), including SOTRs. However, clinical data for bebtelovimab, the sole currently available anti-spike monoclonal antibody for COVID-19, is limited. METHODS: We conducted a retrospective cohort study of adult SOTRs diagnosed with mild-to-moderate COVID-19 from January 2022 through May 2022 who received either bebtelovimab or sotrovimab. The primary outcome was COVID-19-related hospitalization within 30 days of COVID-19 diagnosis. Data were analyzed with Fisher's exact test. RESULTS: Among 361 SOTRs, 92 (25.5%) received bebtelovimab and 269 (74.5%) received sotrovimab. The most common organ transplant was a kidney (42.4%). SOTRs who received bebtelovimab had a higher proportion who had received a booster SARS-CoV-2 vaccine dose and had received their last vaccination dose more recently. Eleven (3.0%) SOTRs were hospitalized, and rates of hospitalization were similar between monoclonal antibody groups (3.3% versus 3.0%; p > .99). Three patients required admission to an intensive care unit, all of who received sotrovimab. Four (1.1%) patients died within 30 days of COVID-19 diagnosis, two from each group. CONCLUSIONS: SOTRs with mild-to-moderate COVID-19 who received bebtelovimab had similar rates of COVID-19-related hospitalization as those who received sotrovimab. While differences in vaccination rates and viral subvariants could act as confounders, bebtelovimab appears to be of similar effectiveness as sotrovimab.

6.
Transpl Int ; 35: 10332, 2022.
Article in English | MEDLINE | ID: covidwho-1933951

ABSTRACT

Infections are leading causes of morbidity/mortality following solid organ transplantation (SOT) and cytomegalovirus (CMV) is among the most frequent pathogens, causing a considerable threat to SOT recipients. A survey was conducted 19 July-31 October 2019 to capture clinical practices about CMV in SOT recipients (e.g., how practices aligned with guidelines, how adequately treatments met patients' needs, and respondents' expectations for future developments). Transplant professionals completed a ∼30-minute online questionnaire: 224 responses were included, representing 160 hospitals and 197 SOT programs (41 countries; 167[83%] European programs). Findings revealed a heterogenous approach to CMV diagnosis and management and, sometimes, significant divergence from international guidelines. Valganciclovir prophylaxis (of variable duration) was administered by 201/224 (90%) respondents in D+/R- SOT and by 40% in R+ cases, with pre-emptive strategies generally reserved for R+ cases: DNA thresholds to initiate treatment ranged across 10-10,000 copies/ml. Ganciclovir-resistant CMV strains were still perceived as major challenges, and tailored treatment was one of the most important unmet needs for CMV management. These findings may help to design studies to evaluate safety and efficacy of new strategies to prevent CMV disease in SOT recipients, and target specific educational activities to harmonize CMV management in this challenging population.


Subject(s)
COVID-19 , Cytomegalovirus Infections , Organ Transplantation , Antiviral Agents/therapeutic use , Cytomegalovirus , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/prevention & control , Ganciclovir/therapeutic use , Humans , Organ Transplantation/adverse effects , Surveys and Questionnaires , Transplant Recipients
7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927835

ABSTRACT

Invasive aspergillosis is a rapidly progressive, fatal infection that usually occurs in immunocompromised patients. The spectrum of clinical presentation ranges from non-invasive, invasive, destructive and allergic aspergillosis. It is rare to see overwhelming aspergillosis in an immunocompetent host. Nevertheless, certain risk factors such as underlying fibrotic lung disease, suppurative infection, long-term corticosteroid use and uncontrolled diabetes mellitus (DM) have been described. We hereby present a case of invasive pulmonary aspergillosis in a patient with uncontrolled DM. A 60-year-old man with a history of heavy smoking (50- pack-year), poorly controlled DM presented to the hospital with a large area of erythema with eschar over his left posterior thigh. Clinical examination and CT abdomen pelvis confirmed necrotizing fasciitis involving his perineum and left thigh. Admission CT abdomen showed a small left lower lobe infiltrate (Day 1, Panel A). He underwent urgent debridement and intraoperative tissue cultures grew coagulase-negative staphylococcus, Proteus Vulgaris and anaerobic gram-positive rods. He received piperacillintazobactam, vancomycin, and clindamycin for 16 days which was subsequently narrowed to ceftriaxone and metronidazole. He had worsening leukocytosis but all his blood cultures have been negative. Tracheal aspirate gram stain on day 5 showed moderate yeast, and cultures grew Candida albicans and Aspergillus fumigatus. CT scan of his chest showed bilateral reticulonodular opacities with a new loculated right pleural effusion (Day 16, Panel B). Trans-esophageal echocardiogram did not show any right-sided heart valve vegetation. He received intravenous voriconazole for disseminated aspergillosis. Despite of new prophylactic antifungal strategies, more sensitive and rapid diagnostic tests, as well as various efficacious treatments, survival of invasive disseminated aspergillosis remains poor. High clinical suspicion with a proactive investigation approach is the key to minimizing mortality. Various risk factors such as hematopoietic-cell transplantation, neutropenia, solid-organ transplantation, chemotherapy, prolonged ICU stay, structural lung disease, impaired mucociliary clearance after a recent pulmonary infection (including SARS-CoV-2) have been well described. Our case highlights the importance of recognizing uncontrolled DM as a crucial risk factor for disseminated aspergillosis. (Figure Presented).

8.
Am J Transplant ; 2022 Jul 13.
Article in English | MEDLINE | ID: covidwho-1927554

ABSTRACT

The COVID-19 pandemic has influenced organ transplantation decision making. Opinions regarding the utilization of coronavirus disease-2019 (COVID-19) donors are mixed. We hypothesize that COVID-19 infection of deceased solid organ transplant donors does not affect recipient survival. All deceased solid organ transplant donors with COVID-19 testing results from March 15, 2020 to September 30, 2021 were identified in the OPTN database. Donors were matched to recipients and stratified by the COVID-19 test result. Outcomes were assessed between groups. COVID-19 test results were available for 17 694 donors; 150 were positive. A total of 269 organs were transplanted from these donors, including 187 kidneys, 57 livers, 18 hearts, 5 kidney-pancreases, and 2 lungs. The median time from COVID-19 testing to organ recovery was 4 days for positive and 3 days for negative donors. Of these, there were 8 graft failures (3.0%) and 5 deaths (1.9%). Survival of patients receiving grafts from COVID-19-positive donors is equivalent to those receiving grafts from COVID-19-negative donors (30-day patient survival = 99.2% COVID-19 positive; 98.6% COVID-19 negative). Solid organ transplantation using deceased donors with positive COVID-19 results does not negatively affect early patient survival, though little information regarding donor COVID-19 organ involvement is known. While transplantation is feasible, more information regarding COVID-19-positive donor selection is needed.

9.
Am J Transplant ; 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1927553

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has been associated with a high risk of adverse outcomes in solid organ transplant (SOT) recipients in the pre-vaccination era. In this retrospective cohort study, we examined the incidence and severity of COVID-19 in kidney and liver transplant recipients in Denmark in the post-vaccination era, from December 27, 2020, to December 27, 2021. We included 1428 SOT recipients with 143 cases of first-positive SARS-CoV-2 PCR test. The cumulative incidence of first-positive SARS-CoV-2 PCR test 1 year after initiation of vaccination was 10.4% (95% CI: 8.8-12.0), and the incidence was higher in kidney than in liver transplant recipients (11.6% [95% CI: 9.4-13.8] vs. 7.4% [95% CI: 5.1-9.8], p = .009). After the first-positive SARS-CoV-2 PCR test, the hospitalization rate was 31.5% (95% CI: 23.9-39.1), and 30-day all-cause mortality was 3.7% (95% CI: 0.5-6.8). Hospitalization was lower in vaccinated than in unvaccinated SOT recipients (26.4% [95% CI: 18.1-34.6] vs. 48.5% [95% CI: 31.4-65.5], p = .011), as was mortality (1.8% [95% CI: 0.0-4.3] vs. 9.1% [95% CI: 0.0-18.9], p = .047). In conclusion, SOT recipients remain at high risk of adverse outcomes after SARS-CoV-2 infections, with a lower risk observed in vaccinated than in unvaccinated SOT recipients.

10.
Farmaceutski Glasnik ; 78(1-2):15-28, 2022.
Article in Croatian | EMBASE | ID: covidwho-1925189

ABSTRACT

Organ transplantation in the final stages of chronic disease or in case of acute failure is an accepted procedure of treating patients that has been developing for many years. After the organ transplantation procedure, immunosuppressive therapy is started, which strikes a balance between the modulation of the immune system in order to avoid organ rejection or the harmful effects of immunosuppression. Commonly used immunosuppressants for the treatment of transplant patients are from the group of calcineurin inhibitors (cyclosporine, tacrolimus) and mTOR inhibitors (sirolimus, everolimus). Mycophenolic acid, leflunomide and glucocorticoids are used as supportive therapy, and with the discovery of biological therapy, therapeutic monoclonal antibodies directed against various cellular targets have been developed. Optimization and laboratory monitoring of immunosuppressive concentrations is necessary after transplantation in order to avoid graft rejection and the occurrence of unwanted side effects. The most commonly used methods for therapeutic drug monitoring in clinical laboratories are immunochemical methods characterized by high levels of automation but also have major shortcomings such as insufficient specificity and standardization, which is why the method of choice for therapeutic monitoring is liquid chromatography-tandem mass spectrometry whose main characteristic is specificity and selectivity. Therefore, when measuring the concentration of immunosuppressants, it is important to state the method of determination. The global spread of Coronavirus disease (COVID-19) has affected organ donation and transplantation and is actively trying to clarify the role of immunosuppressive therapy in the disease process because it is extremely difficult to strike a balance between suppressing the immune response to prevent organ rejection and control inflammation during COVID-19 disease. Given the complexity of treating the transplant population of patients with COVID-19, there is a clear need for a systemic approach to treatment, which will consequently lead to better outcomes.

11.
Front Immunol ; 13: 888385, 2022.
Article in English | MEDLINE | ID: covidwho-1924104

ABSTRACT

Objective: This is the first systematic review and meta-analysis to determine the factors that contribute to poor antibody response in organ transplant recipients after receiving the 2-dose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Method: Data was obtained from Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM). Studies reporting factors associated with antibody responses to the 2-dose SARS-CoV-2 vaccine in solid organ transplant recipients were included in our study based on the inclusion and exclusion criteria. Two researchers completed the literature search, screening, and data extraction. Randomized models were used to obtain results. Egger's test was performed to determine publication bias. Sensitivity analysis was performed to determine the stability of the result. The heterogeneity was determined using the Galbraith plot and subgroup analysis. Results: A total of 29 studies were included in the present study. The factors included living donor, BNT162b2, tacrolimus, cyclosporine, antimetabolite, mycophenolic acid (MPA) or mycophenolate mofetil (MMF), azathioprine, corticosteroids, high-dose corticosteroids, belatacept, mammalian target of rapamycin (mTOR) inhibitor, tritherapy, age, estimated glomerular filtration rate (eGFR), hemoglobin, and tacrolimus level were significantly different. Multivariate analysis showed significant differences in age, diabetes mellitus, MPA or MMF, high-dose corticosteroids, tritherapy, and eGFR. Conclusion: The possible independent risk factors for negative antibody response in patients with organ transplants who received the 2-dose SARS-CoV-2 vaccine include age, diabetes mellitus, low eGFR, MPA or MMF, high-dose corticosteroids, and triple immunosuppression therapy. mTOR inhibitor can be a protective factor against weak antibody response. Systematic Review Registration: PROSPERO, identifier CRD42021257965.


Subject(s)
COVID-19 , Diabetes Mellitus , Kidney Transplantation , Adult , Antibody Formation , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Diabetes Mellitus/drug therapy , Graft Rejection/prevention & control , Humans , Kidney Transplantation/methods , Mycophenolic Acid , Risk Factors , SARS-CoV-2 , TOR Serine-Threonine Kinases , Tacrolimus
12.
Am J Transplant ; 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1922817

ABSTRACT

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization and death, and the effects of SARS-CoV-2 vaccines in solid organ transplant recipients (SOTRs) is still debated. We performed a nationwide, population-based, matched cohort study, including all Danish SOTRs (n = 5184) and a matched cohort from the general population (n = 41 472). Cox regression analyses were used to calculate incidence rate ratios (IRRs). SOTRs had a slightly increased risk of SARS-CoV-2 infection and were vaccinated earlier than the general population. The overall risk of hospital contact with COVID-19, severe COVID-19, need for assisted respiration, and hospitalization followed by death was substantially higher in SOTRs (IRR: 32.8 95%CI [29.0-37.0], 9.2 [6.7-12.7], 12.5 [7.6-20.8], 12.4 [7.9-12.7]). The risk of hospitalization and death after SARS-CoV-2 infection decreased substantially in SOTRs after the emergence of the Omicron variant (IRR: 0.45 [0.37-0.56], 0.17 [0.09-0.30]). Three vaccinations reduced the risk of SARS-CoV-2 infection only marginally compared to two vaccinations, but SOTRs with three vaccinations had a lower risk of death (IRR: 022 [0.16-0.35]). We conclude that SOTRs have a risk of SARS-CoV-2 infection comparable to the general population, but substantially increased the risk of hospitalization and death following SARS-CoV-2 infection. A third vaccination only reduces the risk of SARS-CoV2 infection marginally, but SOTRs vaccinated 3 times have reduced mortality.

13.
BMC Med Ethics ; 23(1): 69, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-1916950

ABSTRACT

Consent in medical practice is a process riddled with layers of complexities. To some extent, this is inevitable given that different medical conditions raise different sets of issues for doctors and patients. Informed consent and risk assessment are highly significant public health issues that have become even more prominent during the course of the Covid-19 pandemic. In this article we identity relevant factors for clinicians to consider when ensuring consent for solid organ transplantation. Consent to undergo solid organ transplantation is more complex than most surgical and other clinical interventions because of the many factors involved, the complexity of the options and the need to balance competing risks. We first out the context in which consent is given by the patient. We then outline the legal principles pertaining to consent in medical practice as it applies in the UK and the implication of recent legal judgments. The third section highlights specific complexities of consent in organ transplantation and identifies relevant factors in determining consent for organ transplantation. The fourth section offers practical recommendations. We propose a novel 'multi-factor approach' to informed consent in transplantation which includes understanding risk, effective communication, and robust review processes. Whilst understanding risk and communication are a given, our suggestion is that including review processes into the consent process is essential. By this we specifically mean identifying and creating room for discretion in decision-making to better ensure that informed consent is given in practice. Discretion implies that health care professionals use their judgement to use the legal judgements as guidance rather than prescriptive. Discretion is further defined by identifying the relevant options and scope of clinical and personal factors in specified transplantation decisions. In particular, we also highlight the need to pay attention to the institutional dimension in the consent process. To that end, our recommendations identify a gap in the current approaches to consent. The identification of areas of discretion in decision-making processes is essential for determining when patients need to be involved. In other words, clinicians and healthcare professionals need to consider carefully when there is room for direction and where there is little or no room for exercising discretion. In sum, our proposed approach is a modest contribution to the on-going debate about consent in medicine.


Subject(s)
COVID-19 , Organ Transplantation , Communication , Humans , Informed Consent , Pandemics
14.
Transplant Rev (Orlando) ; 36(3): 100710, 2022 07.
Article in English | MEDLINE | ID: covidwho-1915060

ABSTRACT

BACKGROUND: The COVID-19 pandemic has a great impact on solid organ transplant (SOT) recipients due to their comorbidities and their maintenance immunosuppression. So far, studies about the different aspects of the impact of the pandemic on SOT recipients are limited. OBJECTIVES: This systematic review summarizes the risk factors that make SOT patients more vulnerable for severe COVID-19 disease or mortality and the impact of immunosuppressive therapy. Furthermore, their clinical outcomes, mortality risk, immunosuppression, immunity and COVID-19 vaccination efficacy are discussed. METHODS: A systematic search on PubMed was performed to select original articles on SOT recipients concerning the following four topics: (1) mortality and clinical course; (2) risk factors for mortality and composite outcomes; (3) maintenance immunosuppression; (4) immunity to COVID-19 infection and (5) vaccine immunogenicity. Relevant data were extracted, analyzed and summarized in tables. RESULTS: This systematic review includes 77 articles. Mortality was associated with advanced age. Post-transplantation time or comorbidities were variably identified as independent risk factors for mortality or severe disease. However, generally, no comorbidity was reported as a major risk factor. SOT recipients have a higher risk of acute kidney injury, but no higher rate of mortality compared to non-transplanted patients was found. Immunosuppression was individually adjusted, without leading to high rates of graft dysfunction. Generally, no association between type of immunosuppression and mortality was found. SOT patients established humoral and cellular immune responses after COVID-19 disease comparable to immunocompetent people. At last, SOT patients experience a diminished immune response after two-dose vaccination with SARS-COV-2-mRNA-vaccines. CONCLUSION: More research is needed to address the direct effect of COVID-19 disease on the graft in lung transplant recipients, as well as the factors ameliorating the immune response in SOT recipients.


Subject(s)
COVID-19 , Organ Transplantation , COVID-19 Vaccines , Humans , Organ Transplantation/adverse effects , Pandemics , SARS-CoV-2 , Transplant Recipients
15.
16.
Eur J Radiol Open ; 9: 100431, 2022.
Article in English | MEDLINE | ID: covidwho-1906978

ABSTRACT

Purpose: To compare temporal evolution of imaging features of coronavirus disease 2019 (COVID-19) and influenza in computed tomography and evaluate their predictive value for distinction. Methods: In this retrospective, multicenter study 179 CT examinations of 52 COVID-19 and 44 influenza critically ill patients were included. Lung involvement, main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings were evaluated by two independent observers. Additional findings and clinical data were compared patient-wise. A decision tree analysis was performed to identify imaging features with predictive value in distinguishing both entities. Results: In contrast to influenza patients, lung involvement remains high in COVID-19 patients > 14 days after the diagnosis. The predominant pattern in COVID-19 evolves from ground glass at the beginning to consolidation in later disease. In influenza there is more consolidation at the beginning and overall less ground glass opacity (p = 0.002). Decision tree analysis yielded the following: Earlier in disease course, pleural effusion is a typical feature of influenza (p = 0.007) whereas ground glass opacities indicate COVID-19 (p = 0.04). In later disease, particularly more lung involvement (p < 0.001), but also less pleural (p = 0.005) and pericardial (p = 0.003) effusion favor COVID-19 over influenza. Regardless of time point, less lung involvement (p < 0.001), tree-in-bud (p = 0.002) and pericardial effusion (p = 0.01) make influenza more likely than COVID-19. Conclusions: This study identified differences in temporal evolution of imaging features between COVID-19 and influenza. These findings may help to distinguish both diseases in critically ill patients when laboratory findings are delayed or inconclusive.

17.
Curr Transplant Rep ; 9(2): 95-107, 2022.
Article in English | MEDLINE | ID: covidwho-1906612

ABSTRACT

Purpose of Review: As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. Recent Findings: We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. Summary: In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.

18.
Am J Transplant ; 2022 Jun 22.
Article in English | MEDLINE | ID: covidwho-1901570

ABSTRACT

Coronavirus disease-19 has had a marked impact on the transplant population and processes of care for transplant centers and organ allocation. Several single-center studies have reported successful utilization of deceased donors with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests. Our aims were to characterize testing, organ utilization, and transplant outcomes with donor SARS-CoV-2 status in the United States. We used Scientific Registry of Transplant Recipients data from March 12, 2020 to August 31, 2021 including a custom file with SARS-CoV-2 testing data. There were 35 347 donor specimen SARS-CoV-2 tests, 77.5% upper respiratory samples, 94.6% polymerase chain reaction tests, and 1.2% SARS-CoV-2-positive tests. Donor age, gender, history of hypertension, and diabetes were similar by SARS-CoV-2 status, while positive SARS-CoV-2 donors were more likely African-American, Hispanic, and donors after cardiac death (p-values <.01). Recipient demographic characteristics were similar by donor SARS CoV-2 status. Adjusted donor kidney discard (odds ratio = 2.08, 95% confidence interval [CI] 1.66-2.61) was higher for SARS-CoV-2-positive donors while donor liver (odds ratio = 0.44, 95% CI 0.33-0.60) and heart recovery (odds ratio = 0.44, 95% CI 0.31-0.63) were significantly reduced. Overall post-transplant graft survival for kidney, liver, and heart recipients was comparable by donor SARS-CoV-2 status. Cumulatively, there has been significantly lower utilization of SARS-CoV-2 donors with no evidence of reduced recipient graft survival with variations in practice over time.

19.
Am J Transplant ; 2022 Jun 21.
Article in English | MEDLINE | ID: covidwho-1895940

ABSTRACT

Potential regional variations in effects of COVID-19 on federally mandated, program-specific evaluations by the Scientific Registry of Transplant Recipients (SRTR) have been controversial. SRTR January 2022 program evaluations ended transplant follow-up on March 12, 2020, and excluded transplants performed from March 13, 2020 to June 12, 2020 (the "carve-out"). This study examined the carve-out's impact, and the effect of additionally censoring COVID-19 deaths, on first-year posttransplant outcomes for transplants from July 2018 through December 2020. Program-specific hazard ratios (HRs) for graft failure and death estimated under two alternative scenarios were compared with published HRs: (1) the carve-out was removed; (2) the carve-out was retained, but deaths due to COVID-19 were additionally censored. The HRs estimated by censoring COVID-19 deaths were highly correlated with those estimated with the carve-out alone (r2  = .96). Removal of the carve-out resulted in greater variation in HRs while remaining highly correlated (r2  = .82); however, little geographic impact of the carve-out was observed. The carve-out increased average HR in the Northwest by 0.049; carve-out plus censoring reduced average HR in the Midwest by 0.009. Other regions of the country were not significantly affected. Thus, the current COVID-19 carve-out does not appear to impart substantial bias based on the region of the country.

20.
Am J Transplant ; 2022 Jun 17.
Article in English | MEDLINE | ID: covidwho-1895939

ABSTRACT

The cilgavimab-tixagevimab combination retains a partial in vitro neutralizing activity against the current SARS-CoV-2 variants of concern (omicron BA.1, BA.1.1, and BA.2). Here, we examined whether preexposure prophylaxis with cilgavimab-tixagevimab can effectively protect kidney transplant recipients (KTRs) against the omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of 150 mg tixagevimab and 150 mg cilgavimab, 39 (9.4%) developed COVID-19. With the exception of one case, all patients were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients (7.7%), respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n = 1). Viral neutralizing activity of the serum against the BA.1 variant was negative in the 12 tested patients, suggesting that this prophylactic strategy does not provide sufficient protection against this variant of concern. In summary, preexposure prophylaxis with cilgavimab-tixagevimab at the dose of 150 mg of each antibody does not adequately protect KTRs against omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential.

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