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2.
Ann Transplant ; 26: e929279, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1154830

ABSTRACT

Coronavirus disease 19 (COVID-19) has been an ongoing pandemic since December 2019. Unfortunately, kidney transplant recipients are a high-risk group during the disease course, and scientific data are still limited in this patient group. Beyond the dosage of immunosuppressive drugs, pharmacological immunosuppression may also alter the infection response in the COVID-19 course. The effects of immunosuppressive agents on the development and process of infection should not be decided only by determining how potent they are and how much they suppress the immune system; it is also thought that the direct effect of the virus, increased oxidative stress, and cytokine storm play a role in the pathogenesis of COVID-19 disease. There are data about immunosuppressive drugs like calcineurin inhibitors (CNI) or mammalian target of rapamycin inhibitors (mTORi) therapy related to their beneficial effects during any infection course. Limited data suggest that the use of CNI or mTORi may have beneficial effects on the process. In this hypothetical review, the probable impacts of CNI and mTORi on the pathogenesis of the COVID-19 were investigated.


Subject(s)
COVID-19/immunology , Calcineurin Inhibitors/therapeutic use , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Postoperative Complications/immunology , Protein Kinase Inhibitors/therapeutic use , Adaptive Immunity/drug effects , COVID-19/diagnosis , Calcineurin Inhibitors/pharmacology , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/prevention & control , Cytokine Release Syndrome/virology , Graft Rejection/immunology , Humans , Immunity, Innate/drug effects , Immunocompromised Host , Immunosuppressive Agents/pharmacology , Oxidative Stress/drug effects , Oxidative Stress/immunology , Postoperative Complications/diagnosis , Postoperative Complications/virology , Protein Kinase Inhibitors/pharmacology , TOR Serine-Threonine Kinases/antagonists & inhibitors
3.
Transplant Proc ; 53(4): 1160-1168, 2021 May.
Article in English | MEDLINE | ID: covidwho-1135578

ABSTRACT

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised concern for the health of immunocompromised individuals, who are potentially at higher risk of more severe infection and poorer outcomes. As a large London transplant center serving a diverse patient population, we report the outcomes of SARS-CoV-2 infection in our cohort of 2848 kidney and/or pancreas transplant patients. METHODS: Data were obtained retrospectively for all transplant patients who attended hospital during the peak of the pandemic and had a positive nasopharyngeal SARS-CoV-2 test. RESULTS: Sixty-six patients were found to be positive for SARS-CoV-2. Twenty percent were treated as outpatients, 59% were admitted to the general ward, and 21% required intensive care. Treatment consisted of reduced immunosuppression, antibiotics for pneumonia or sepsis, and other supportive treatments. Within our cohort, 12 patients died (18%), with an overall mortality of 0.4%. Predictive risk factors for COVID-19 severity were explored. CONCLUSIONS: Severe disease was associated with lower hemoglobin prior to COVID-19 diagnosis and lower lymphocyte count at the time of diagnosis but not age, sex, ethnicity, or preexisting comorbidities. Lower glomerular filtration rate and higher C-reactive protein were associated with more severe disease. Despite no use of hydroxychloroquine, azithromycin, antiviral, or immunomodulatory medications, our mortality rate (kidney and pancreas transplant patients) is similar to current international rates.


Subject(s)
COVID-19/epidemiology , Immunocompromised Host/immunology , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Postoperative Complications/epidemiology , SARS-CoV-2/immunology , Adult , Aged , COVID-19/immunology , COVID-19/virology , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Postoperative Complications/immunology , Postoperative Complications/virology , Retrospective Studies , Risk Factors , Severity of Illness Index , United Kingdom/epidemiology
5.
Transplant Proc ; 53(4): 1112-1117, 2021 May.
Article in English | MEDLINE | ID: covidwho-978451

ABSTRACT

BACKGROUND: In liver transplant (LT) recipients with severe coronavirus disease 2019 (COVID-19), fatal outcome has been reported in a substantial subset of patients. Whether LT recipients are at increased risk for severe COVID-19 compared with the general population is controversial. Here we report the results of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in a large LT recipient cohort. METHODS: A total of 219 LT recipients were enrolled between May 5, 2020, and August 6, 2020, at the University Hospital Heidelberg. Serum blood samples were collected and tested for anti-SARS-CoV-2 IgG. SARS-CoV-2 RNA was detected in nasopharyngeal swabs using reverse transcription-polymerase chain reaction assays. RESULTS: Taking into account known risk factors of arterial hypertension, obesity, diabetes, or leukopenia, LT recipients a priori represented a high-risk cohort for severe COVID-19 with 101 of 219 (46.1%) presenting with more than 2 risk factors for severe COVID-19. Out of 219 LT recipients, 8 (3.7%) either had a positive test result for nasopharyngeal SARS-CoV-2 RNA or anti-SARS-CoV-2 serum IgG. Five of eight (62.5%) did not show any clinical signs of infection, three of eight (37.5%) had self-limited disease, and none required hospitalization for COVID-19. Two of eight (25%) had known exposure to infected health care staff as the probable source of infection. CONCLUSIONS: In summary, LT recipients showed a SARS-CoV-2 seroconversion rate similar to that of the general population with a substantial percentage of unrecognized infections.


Subject(s)
COVID-19/epidemiology , Liver Transplantation/adverse effects , Postoperative Complications/epidemiology , SARS-CoV-2/immunology , Adult , Antibodies, Viral/blood , COVID-19/immunology , Female , Germany/epidemiology , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Male , Middle Aged , Postoperative Complications/immunology , Prospective Studies , RNA, Viral/blood , Risk Factors , Seroconversion , Seroepidemiologic Studies
6.
Transplant Proc ; 53(4): 1118-1125, 2021 May.
Article in English | MEDLINE | ID: covidwho-978450

ABSTRACT

INTRODUCTION: Living-donor liver transplantation (LDLT) has been mostly suspended and deceased-donor living transplantation activity has been considerably reduced because of coronavirus disease 2019 (COVID-19). We modified our protocols and procedures in line with COVID-19 guidelines. Since the restructuring, we have performed 20 LDLTs. Our study reports the outcomes of these cases and demonstrates the feasibility of LDLT during this pandemic. MATERIALS AND METHODS: The changes were influenced by experiences and communications from across the globe. A month-long self-imposed moratorium was spent in restructuring the program and implementing new protocols. Twenty LDLTs were performed between April 18 and September 15 using the new protocols. Our experience includes 2 simultaneous liver-kidney transplants, 1 ABO-incompatible LDLT, and 1 pediatric case (age 11 months). RESULTS: Nineteen patients recovered and 1 patient died. We maintained our postoperative immunosuppression protocol without many changes. Major complications were observed in 30% of recipients but none of the donors. One recipient was infected with COVID-19 during the postoperative period. A donor-recipient couple contracted COVID-19 after discharge from the hospital. All patients recovered from COVID-19 and liver enzymes were unaffected. CONCLUSION: This study represents a microcosm of experience in LDLT during the COVID-19 era. Outcomes of LDLT are not affected by COVID-19 per se, provided that we make necessary changes.


Subject(s)
COVID-19/prevention & control , Infection Control/methods , Liver Transplantation/methods , Postoperative Complications/prevention & control , SARS-CoV-2 , ABO Blood-Group System , Adult , Blood Group Incompatibility , COVID-19/immunology , COVID-19/virology , Female , Humans , Infant , Liver Transplantation/adverse effects , Liver Transplantation/standards , Living Donors , Male , Middle Aged , Postoperative Complications/immunology , Postoperative Complications/virology , Postoperative Period , Treatment Outcome
7.
Transplant Proc ; 52(9): 2620-2625, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-899626

ABSTRACT

Kidney transplant recipients who develop symptoms consistent with coronavirus disease 2019 (COVID-19) are bringing unique challenges to health care professionals. Telemedicine has surged dramatically since the pandemic in effort to maintain patient care and reduce the risk of COVID-19 exposure to patients, health care workers, and the public. Herein we present reports of 3 kidney transplant recipients with COVID-19 who were managed using telemedicine via synchronous video visits integrated with an electronic medical record system, from home to inpatient settings. We demonstrate how telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. While there is limited information about the duration of viral shedding for immunosuppressed patients, our findings underscore the importance of using telemedicine in the follow-up care for kidney transplant recipients with COVID-19 who have recovered from symptoms but might have persistently positive nucleic acid tests. Our experience emphasizes the opportunities of telemedicine in the management of kidney transplant recipients with COVID-19 and in the maintenance of uninterrupted follow-up care for such immunosuppressed patients with prolonged viral shedding. Telemedicine may help increase access to care for kidney transplant recipients during and beyond the pandemic as it offers a prompt, safe, and convenient platform in the delivery of care for these patients. Yet, to advance the practice of telemedicine in the field of kidney transplantation, barriers to increasing the widespread implementation of telemedicine should be removed, and research studies are needed to assess the effectiveness of telemedicine in the care of kidney transplant recipients.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/therapy , Kidney Transplantation/adverse effects , Pneumonia, Viral/therapy , Postoperative Complications/therapy , Telemedicine/methods , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Female , Humans , Immunocompromised Host/immunology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Postoperative Complications/diagnosis , Postoperative Complications/immunology , SARS-CoV-2
9.
Am J Transplant ; 21(2): 854-863, 2021 02.
Article in English | MEDLINE | ID: covidwho-852162

ABSTRACT

Immunosuppressed organ-transplanted patients are considered at risk for severe forms of COVID-19. Moreover, exaggerated innate and adaptive immune responses might be involved in severe progression of the disease. However, no data on the immune response to SARS-CoV-2 in transplanted patients are currently available. Here, we report the first assessment of antibody and T cell responses to SARS-CoV-2 in 11 kidney-transplanted patients recovered from RT-PCR-confirmed (n = 5) or initially suspected (n = 6) COVID-19. After reduction of immunosuppressive therapy, RT-PCR-confirmed COVID-19 transplant patients were able to mount vigorous antiviral T cell and antibody responses, as efficiently as two nontherapeutically immunosuppressed COVID-19 patients on hemodialysis. By contrast, six RT-PCR-negative patients displayed no antibody response. Among them, three showed very low numbers of SARS-CoV-2-reactive T cells, whereas no T cell response was detected in the other three, potentially ruling out COVID-19 diagnosis. Low levels of T cell reactivity to SARS-CoV-2 were also detected in seronegative healthy controls without known exposure to the virus. These results suggest that during COVID-19, monitoring both T cell and serological immunity might be helpful for the differential diagnosis of COVID-19 but are also needed to evaluate a potential role of antiviral T cells in the development of severe forms of the disease.


Subject(s)
Antibodies, Viral/immunology , Antibody Formation , COVID-19/immunology , Immunocompromised Host , Kidney Transplantation , Postoperative Complications/immunology , T-Lymphocytes/immunology , Adult , Aged , Antibodies, Viral/metabolism , Antigens, Viral/immunology , Biomarkers/metabolism , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/etiology , COVID-19 Nucleic Acid Testing , Case-Control Studies , Enzyme-Linked Immunospot Assay , Female , France/epidemiology , Humans , Male , Middle Aged , Pandemics , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Renal Dialysis , T-Lymphocytes/metabolism
10.
Transplant Proc ; 52(9): 2637-2641, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-813884

ABSTRACT

Here we report a single-center cohort of 6 patients (4 kidney only, and 2 simultaneous liver/kidney transplants) diagnosed with COVID-19 at a median of 1.9 years (range = 0.2-9.3 years) post transplant. Five (of 6) patients required inpatient admission, 2 patients (mortality = 33%) died. Among those with mortality, an increased concentration of inflammatory biomarkers (interleukin-6 and C-reactive protein) was noted with a lack of response to interleukin-6 blockade, remdesivir, and/or convalescent plasma. None of the kidney-only transplants (4/6; 67%) had elevation in plasma donor-derived cell-free DNA above the previously published cut-off of 1%, suggesting absence of significant allo-immune injury. Four (of 5) admitted patients had detectable SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) in blood on samples obtained at/during hospitalization. Of the 4 discharged patients, 2 patients with undetectable virus on repeat nasopharyngeal swabs had seroconversion with positive SARS-CoV-2 IgG formation at 30 to 48 days post infection. One patient had prolonged shedding of virus on nasopharyngeal swab at 28 days post discharge despite lack of symptoms. In this preliminary report, we find that immunocompromised transplant patients had higher rates of RNAemia (67%) than reported in the general population (15%), seeming absence of allo-immune injury despite systemic inflammation, and formation of IgG overtime after recovery from infection.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Immunocompromised Host/immunology , Kidney Transplantation/adverse effects , Pneumonia, Viral/immunology , Postoperative Complications/immunology , Adult , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Coronavirus Infections/virology , Female , Hospitalization/statistics & numerical data , Humans , Immunization, Passive , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Postoperative Complications/mortality , Postoperative Complications/virology , SARS-CoV-2 , Viremia/immunology , Viremia/mortality , Viremia/virology
11.
Clin Transplant ; 34(12): e14091, 2020 12.
Article in English | MEDLINE | ID: covidwho-772451

ABSTRACT

A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes of 5 OHT recipients and one combined heart-lung recipient with confirmed SARS-CoV-2 were obtained. The cohort was predominately African American males with median age of 59 years (interquartile range, 48.25-73.25). All patients were classified as having mild-moderate disease; none required intubation or ICU admission with no deaths. The most common presenting symptoms were fever and shortness of breath 83% (n = 5), followed by cough and chills 67% (n = 4). All admitted patients (n = 5) received hydroxychloroquine and 3 received high-dose steroids. Antimetabolites were held for 2 patients (33.3%). The calcineurin inhibitor trough goal was decreased in only 1 patient; 3 other patients, without change in goal, required calcineurin inhibitor dosage reduction. Two patients requiring readmission presented 7 and 23 days after initial symptoms onset. In conclusion, our experience with OHT patients infected by the SARS-CoV-2 virus did not have an elevated risk of severe infection. Impact of modifying immunosuppression remains unclear.


Subject(s)
COVID-19/immunology , Heart Transplantation , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Postoperative Complications/immunology , Adult , Aged , COVID-19/diagnosis , COVID-19/etiology , COVID-19/therapy , COVID-19 Testing , Combined Modality Therapy , Female , Graft Rejection/prevention & control , Hospitalization , Humans , Immunosuppressive Agents/therapeutic use , Male , Michigan , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Postoperative Complications/virology , Retrospective Studies , Severity of Illness Index , Treatment Outcome
12.
Transplant Proc ; 52(9): 2607-2613, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-708645

ABSTRACT

The concerns generated by coronavirus disease 2019 (COVID-19) pandemic are having profound impact on solid organ transplantation (SOT). Non-pharmaceutical interventions (NPI) are currently the only measures available to contain COVID-19 in the general population and in more vulnerable recipients of any organ transplant. In this cross-sectional case control study from a patient survey undertaken in 2 transplant centers (TxC) in the Kingdom of Saudi Arabia and Italy, we aimed to appraise awareness of the NPI implemented by respective these governments. We have also evaluated the impact of COVID-19 on our kidney transplant (KT) recipients and a control group of kidney living donors (KLD). In our series, there were zero cases of COVID-19 among 111 KT recipients and 70 KLD of the control group. Demography, transplant type, immunosuppression regimes, and, importantly, the different COVID-19 prevalence in the 2 regions of the TxC did not appear to influence incidence of COVID-19 in our KT recipients. The absence of COVID-19 cases in our series was unexpected. Our findings suggest that awareness of NPI is associated with a successful containment of COVID-19 in vulnerable, immunosuppressed KT recipients.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/epidemiology , Immunocompromised Host/immunology , Kidney Transplantation/adverse effects , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Adult , COVID-19 , Case-Control Studies , Coronavirus Infections/immunology , Cross-Sectional Studies , Female , Humans , Incidence , Italy/epidemiology , Living Donors/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/immunology , Postoperative Complications/immunology , Postoperative Complications/virology , Prevalence , SARS-CoV-2 , Saudi Arabia/epidemiology , Tissue and Organ Harvesting/adverse effects , Tissue and Organ Procurement/statistics & numerical data
13.
Clin Transplant ; 34(11): e14059, 2020 11.
Article in English | MEDLINE | ID: covidwho-697168

ABSTRACT

An unprecedented global pandemic caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has quickly overwhelmed the health care systems worldwide. While there is an absence of consensus among the community in how to manage solid organ transplant recipients and donors, a platform provided by the American Society of Transplantation online community "Outstanding Questions in Transplantation," hosted a collaborative multicenter, multinational discussions to share knowledge in a rapidly evolving global situation. Here, we present a summary of the discussion in addition to the latest published literature.


Subject(s)
COVID-19 , Organ Transplantation , Pandemics , Postoperative Complications , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/immunology , COVID-19/therapy , Global Health , Graft Rejection/prevention & control , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , International Cooperation , Postoperative Complications/epidemiology , Postoperative Complications/immunology , Postoperative Complications/therapy , Societies, Medical
14.
Gastroenterol Hepatol ; 43(8): 457-463, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-639589

ABSTRACT

SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Immunosuppressive Agents/adverse effects , Liver Transplantation , Pandemics , Pneumonia, Viral/epidemiology , Adaptive Immunity , Antiviral Agents/pharmacology , Betacoronavirus/immunology , Betacoronavirus/physiology , COVID-19 , Calcineurin Inhibitors/adverse effects , Calcineurin Inhibitors/pharmacology , Calcineurin Inhibitors/therapeutic use , Contraindications, Drug , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Disease Susceptibility , Drug Interactions , Everolimus/adverse effects , Everolimus/pharmacology , Everolimus/therapeutic use , Glucocorticoids/adverse effects , Glucocorticoids/pharmacology , Glucocorticoids/therapeutic use , Humans , Immunity, Innate , Immunocompromised Host , Immunosuppressive Agents/pharmacology , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/adverse effects , Mycophenolic Acid/pharmacology , Mycophenolic Acid/therapeutic use , Pneumonia, Viral/immunology , Postoperative Complications/immunology , Postoperative Complications/prevention & control , SARS-CoV-2 , Sirolimus/adverse effects , Sirolimus/pharmacology , Sirolimus/therapeutic use , TOR Serine-Threonine Kinases/antagonists & inhibitors
15.
Clin Transplant ; 34(11): e14032, 2020 11.
Article in English | MEDLINE | ID: covidwho-627203

ABSTRACT

There is limited experience in management of orthotopic heart transplant (OHT) patients with COVID-19. In this study, we present our initial experience using a standardized management algorithm. Data collection was performed on OHT patients with COVID-19 after March 10, 2020 (declaration of state of emergency in Massachusetts). Among the 358 OHT patients currently followed at our program, 5 patients (1.4%) tested positive for COVID-19 (median age 50 years [IQR, 49-58], duration post-OHT 21 years [IQR, 6-25], and 4 of 5 [80%] were men). Among the 5 OHT patients, 2 of 5 (20%) had mild disease and had no change in baseline immunosuppression therapy. Two of 5 (20%) had moderate disease and received remdesivir as part of a clinical trial and reduced immunosuppression therapy. One patient (20%) died prior to presenting to the hospital, consistent with 20% case fatality rate. Four patients (80%) are doing well 4 weeks post-discharge. In this small cohort of OHT patients with COVID-19, we report a 1.4% COVID-19 infection rate and 20% case fatality rate. All OHT patients managed under our clinical management algorithm had good short-term outcomes. Further study to estimate the true risk profile of OHT patients and validate the proposed management strategy is warranted.


Subject(s)
COVID-19/immunology , Graft Rejection/prevention & control , Heart Transplantation , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Postoperative Complications/immunology , SARS-CoV-2 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/therapeutic use , Algorithms , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing , Clinical Decision-Making/methods , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Prospective Studies , Quality Improvement , SARS-CoV-2/isolation & purification , Severity of Illness Index , Treatment Outcome
16.
Transplant Proc ; 52(9): 2614-2619, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-624694

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a new infectious disease that emerged in China in late 2019 and is now spreading around the world. Social distancing measures were needed to reduce transmission, and lockdown included restricted access to health care facilities. The impact of COVID-19 on transplant recipients is unknown, but considering their immunosuppression status and associated comorbidities, they should be considered a high-risk population. METHODS: A kidney transplant center in Central Italy implemented a strategy to maintain follow-up of kidney transplant recipients by phone and e-mail during lockdown. Telephone interviews were used to administer a clinical questionnaire to patients, and e-mail was used to receive the results of diagnostic tests conducted in outpatient settings. RESULTS: From March 17 to April 23, 2020, a total of 143 kidney transplant recipients were contacted. Twenty-eight patients needed in-hospital consultation for problems unrelated to COVID-19, 3 of whom needed hospitalization. Eleven patients were managed at home for mild urinary or respiratory diseases, and 1 was referred to the hematologist. We identified 2 suspected cases of COVID-19 infection, and the patients were referred to hospital care. Immunosuppressive therapy was modulated, and intravenous corticosteroids and potentially effective antiviral therapy were administered with a favorable outcome. CONCLUSIONS: In the context of a lockdown, such as that occurring in response to COVID-19, we suggest implementing remote surveillance programs in kidney transplant recipients with the help of any available technology and offering medical consulting and logistic support as needed.


Subject(s)
Aftercare/methods , Coronavirus Infections/prevention & control , Kidney Transplantation/adverse effects , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Postoperative Complications/prevention & control , Telemedicine/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Postoperative Complications/immunology , Postoperative Complications/virology , Quarantine , Risk Factors , SARS-CoV-2
18.
Clin Transplant ; 34(10): e14027, 2020 10.
Article in English | MEDLINE | ID: covidwho-615069

ABSTRACT

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


Subject(s)
COVID-19/immunology , Graft Rejection/prevention & control , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Inflammation/immunology , Organ Transplantation , Postoperative Complications/immunology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Testing , Drug Administration Schedule , Female , Graft Rejection/immunology , Humans , Immunosuppressive Agents/therapeutic use , Inflammation/diagnosis , Inflammation/therapy , Inflammation/virology , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Postoperative Complications/virology , Prognosis , Retrospective Studies , Severity of Illness Index , Young Adult
19.
Transplant Proc ; 52(9): 2584-2591, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-608515

ABSTRACT

The high morbidity and mortality of COVID-19 in immunocompetent patients raises significant concern for immunosuppressed kidney transplant recipients (KTRs). This level of concern, both on the part of the KTRs and transplant professionals, is heightened by a lack of prior knowledge on how Severe Acute Respiratory Syndrome 2 virus (SARS-CoV-2) may manifest differently in immunosuppressed patients. Characterizing how KTRs may present differently than the general population would allow for more targeted and timely evaluation and treatment of KTRs with COVID-19 infection. METHODS: Without prior knowledge of how this virus would affect our transplant center's delivery of care to KTRs who are SARS-CoV-2 positive or patients under investigation, and in the setting of limited testing availability, we initiated a quality assurance and improvement project (QAPI) to track KTRs followed at our transplant center through the SARS-CoV-2 testing process. RESULTS: Of the 53 symptomatic patients, 20 (38%) tested positive for SARS-CoV-2 either on presentation to the emergency department or referral to a designated outpatient testing center. In addition, 16 (80%) of the 20 patients who tested positive required inpatient treatment. Intriguingly, patients with a history of polyoma BK viremia (BKV) had a higher incidence of testing positive for SARS-CoV-2 compared to patients without a history of BKV (80% and 28%, respectively; P = .002). The Positive Predictive Value and Likelihood ratio was 80% and 6.6 for this association, respectively. Among our KTRs tested, those receiving belatacept had a lower likelihood of testing positive for SARS-CoV-2. This finding approached, but did not achieve, statistical significance (P = .06).


Subject(s)
Betacoronavirus/immunology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Immunocompromised Host/immunology , Kidney Transplantation/adverse effects , Pneumonia, Viral/diagnosis , Postoperative Complications/diagnosis , Aged , BK Virus/immunology , COVID-19 , COVID-19 Testing , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , Humans , Male , Middle Aged , Pandemics , Phenotype , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Postoperative Complications/immunology , Postoperative Complications/virology , SARS-CoV-2
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