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Clin Res Cardiol ; 109(12): 1531-1539, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-708875


AIMS: Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. METHODS AND RESULTS: A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). CONCLUSION: Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

COVID-19/epidemiology , Heart Transplantation/adverse effects , Immunosuppressive Agents/adverse effects , Opportunistic Infections/epidemiology , Aged , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , Female , Germany/epidemiology , Health Care Surveys , Humans , Immunocompromised Host , Male , Middle Aged , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Opportunistic Infections/therapy , Risk Factors , Time Factors , Transplant Recipients , Treatment Outcome
Eur Urol ; 77(6): 748-754, 2020 06.
Article in English | MEDLINE | ID: covidwho-72255


BACKGROUND: Previous studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations. OBJECTIVE: To evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients. DESIGN, SETTING, AND PARTICIPANTS: A total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group. INTERVENTION: Immunosuppressant reduction and low-dose methylprednisolone therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis. RESULTS AND LIMITATIONS: The clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure. CONCLUSIONS: Kidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations. PATIENT SUMMARY: Immunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.

Antiviral Agents/administration & dosage , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Glucocorticoids/administration & dosage , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Methylprednisolone/administration & dosage , Opportunistic Infections/drug therapy , Pneumonia, Viral/drug therapy , Transplant Recipients , Adult , Aged , Antiviral Agents/adverse effects , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Female , Glucocorticoids/adverse effects , Humans , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/mortality , Male , Methylprednisolone/adverse effects , Middle Aged , Noninvasive Ventilation , Opportunistic Infections/mortality , Opportunistic Infections/therapy , Opportunistic Infections/virology , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Predictive Value of Tests , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Time Factors , Treatment Outcome , Virus Shedding , Young Adult
Eur Urol ; 77(6): 742-747, 2020 06.
Article in English | MEDLINE | ID: covidwho-27850


Coronavirus disease 2019 (COVID-19) is a novel and lethal infectious disease, posing a threat to global health security. The number of cases has increased rapidly, but no data concerning kidney transplant (KTx) recipients infected with COVID-19 are available. To present the epidemiological, clinical, and therapeutic characteristics of KTx recipients infected with COVID-19, we report on a case series of five patients who were confirmed as having COVID-19 through nucleic acid testing (NAT) from January 1, 2020 to February 28, 2020. The most common symptoms on admission to hospital were fever (five patients, 100%), cough (five patients, 100%), myalgia or fatigue (three patients, 60%), and sputum production (three patients, 60%); serum creatinine or urea nitrogen levels were slightly higher than those before symptom onset. Four patients received a reduced dose of maintenance immunosuppressive therapy during hospitalization. As of March 4, 2020 NAT was negative for COVID-19 in three patients twice in succession, and their computed tomography scans showed improved images. Although greater patient numbers and long-term follow-up data are needed, our series demonstrates that mild COVID-19 infection in KTx recipients can be managed using symptomatic support therapy combined with adjusted maintenance immunosuppressive therapy.

Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Opportunistic Infections/diagnosis , Pneumonia, Viral/diagnosis , Transplant Recipients , Adult , Betacoronavirus/genetics , Betacoronavirus/immunology , COVID-19 , COVID-19 Testing , China , Coronavirus Infections/therapy , Coronavirus Infections/virology , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Male , Middle Aged , Opportunistic Infections/therapy , Opportunistic Infections/virology , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , SARS-CoV-2 , Severity of Illness Index , Time Factors , Treatment Outcome