Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
1.
BMC Nephrol ; 21(1): 419, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: covidwho-810425

RESUMEN

BACKGROUND: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. METHODS: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. RESULTS: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. CONCLUSION: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus , Fallo Renal Crónico , Trasplante de Riñón/estadística & datos numéricos , Pandemias , Neumonía Viral , Terapia de Reemplazo Renal , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Salud Pública/métodos , Sistema de Registros/estadística & datos numéricos , Terapia de Reemplazo Renal/métodos , Terapia de Reemplazo Renal/estadística & datos numéricos , Escocia/epidemiología
2.
Am J Transplant ; 20(9): 2599-2601, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-760102

RESUMEN

The COVID-19 pandemic is spreading worldwide and the impact of the disease in transplant patients is evolving. In this case report, we presented a 63-year-old female kidney transplant recipient who presented with dyspnea and cough and was diagnosed with COVID-19 pneumonia. On the fourth day of admission, the patient's condition worsened. Therefore, the immunosuppressive medications were discontinued, and hydrocortisone was started. The patient died on the fifth day.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Rechazo de Injerto/prevención & control , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/métodos , Neumonía Viral/complicaciones , Receptores de Trasplantes , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Inmunosupresión/métodos , Fallo Renal Crónico/cirugía , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología
3.
J Am Soc Nephrol ; 31(10): 2413-2423, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-732955

RESUMEN

BACKGROUND: COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. METHODS: We enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform. RESULTS: Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19-positive patients. CONCLUSIONS: Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.


Asunto(s)
Comorbilidad , Infecciones por Coronavirus/epidemiología , Huésped Inmunocomprometido/inmunología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Neumonía Viral/epidemiología , Adulto , Anciano , Estudios de Cohortes , Infecciones por Coronavirus/prevención & control , Femenino , Francia , Humanos , Incidencia , Control de Infecciones/organización & administración , Fallo Renal Crónico/epidemiología , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , Estudios Prospectivos , Medición de Riesgo , Análisis de Supervivencia , Receptores de Trasplantes/estadística & datos numéricos
5.
Ann Transplant ; 25: e925755, 2020 Jul 24.
Artículo en Inglés | MEDLINE | ID: covidwho-676253

RESUMEN

Kidney transplantation at the time of the COVID-19 pandemic is challenging. Modifying the immunosuppression protocols is controversial and not evidence based. In this study, we aim to review the published literature of kidney transplant recipients who encountered COVID-19. A literature review was performed using PubMed, ScienceDirect, and World Health Organization databases to identify relevant English-language articles published up to May 7, 2020. There were 24 articles that reported 129 kidney transplant recipients who encountered COVID-19. The age mean was 54.2 years with 73.7% as males. The most commonly reported presentations in order were fever (82.3%), cough (58%), shortness of breath (33.2%), and fatigue (30.7%). Acute kidney injury was observed in 34.1% of patients. Kidney transplant patients encountered COVID-19 were maintained on tacrolimus (Tac, 92%), mycophenolate mofetil (MMF, 78.8%), and prednisone (Pred, 77%) and were manage by holding MMF in 79.1% of patients and holding Tac in 34.4% of patients. In all, 20% of patients needed Intensive Care Unit (ICU) admission and 24.6% of patients required mechanical ventilation. In all, 18.8% of patients had died compared to the reported general population COVID-19 mortality of 3.4%. The clinical presentation of COVID-19 in kidney transplant recipients may be different from the general population with a higher rate of severe disease, complications including renal failure, and mortality.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Salud Global , Control de Infecciones/métodos , Trasplante de Riñón/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/cirugía , Adulto , Bases de Datos Factuales , Femenino , Supervivencia de Injerto , Humanos , Inmunosupresión/métodos , Incidencia , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Medición de Riesgo , Análisis de Supervivencia , Organización Mundial de la Salud
6.
Am J Transplant ; 20(7): 1819-1825, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-642184

RESUMEN

There is minimal information on coronavirus disease 2019 (COVID-19) in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Neumonía Viral/complicaciones , Receptores de Trasplantes , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Cuidados Críticos , Registros Electrónicos de Salud , Femenino , Hospitalización , Humanos , Huésped Inmunocomprometido , Inmunosupresión/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/virología , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Neumonía Viral/mortalidad
8.
CEN Case Rep ; 9(4): 409-412, 2020 11.
Artículo en Inglés | MEDLINE | ID: covidwho-610154

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) caused a pandemic that first discovered in Wuhan, China. While 10% of the patients have asymptomatic infection, 15-20% have lung involvement, 5-10% have multiple organ failure, and macrophage activation syndrome. Chronic respiratory diseases, diabetes mellitus, hypertension, and cancer are risk factors for mortality. Prognosis or optimal treatment strategy for renal transplant recipients in SARS-CoV-2 infection is still unknown. Besides fatal cases, there were also milder case reports. In addition, COVID-19 treatment and the maintenance immunosuppression strategy is still under debate. Antiviral therapies and drug interactions are special topics for these patients. To the best of our knowledge, favipiravir and anti-cytokine treatments have not been previously reported in a kidney transplant recipient with SARS-CoV-2 infection before. We report a case of SARS-CoV-2 infection in a kidney transplant recipient with fatal outcomes.


Asunto(s)
Azitromicina/administración & dosificación , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Hidroxicloroquina/administración & dosificación , Inmunosupresores/administración & dosificación , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Insuficiencia Multiorgánica , Pandemias , Neumonía Viral , Antivirales/administración & dosificación , Deterioro Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Resultado Fatal , Femenino , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Respiración Artificial/métodos , Tomografía Computarizada por Rayos X/métodos
9.
Am J Transplant ; 20(10): 2916-2922, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-401012

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic poses special challenges to immunocompromised transplant patients. Given the paucity of proven data in treating COVID-19, management of these patients is difficult, rapidly evolving, and mainly based on anecdotal experience. We report 2 cases of heart transplant (HT) recipients with COVID-19. The first is a 59-year-old female with HT in 2012 who presented on March 20, 2020 with fever, hypoxia, and ground-glass opacities on chest X-ray. She quickly progressed to acute hypoxic respiratory failure and vasoplegic shock. Despite reduction in immunosuppression and treatment with tocilizumab, intravenous immunoglobulin, hydroxychloroquine, lopinavir/ritonavir, and broad-spectrum antibiotics, she ultimately died from multiorgan failure. The second case is a 75-year-old man with HT in 2000 who presented on April 2, 2020 after curbside testing revealed positive COVID-19. Given a milder presentation compared to the first patient, antimetabolite was discontinued and only hydroxychloroquine was started. Because of a lack of clinical improvement several days later, tocilizumab, methylprednisolone, and therapeutic anticoagulation were initiated. The patient clinically improved with decreasing oxygen requirements and was discharged home. These 2 cases highlight the wide range of different presentations of COVID-19 in HT recipients and the rapidity with which the management of these patients is evolving.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Neumonía Viral/epidemiología , Receptores de Trasplantes , Anciano , Comorbilidad , Resultado Fatal , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresión/métodos , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Pandemias
10.
Am J Transplant ; 20(7): 1882-1884, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-291819

RESUMEN

The clinical manifestation of COVID-19 can vary from an asymptomatic course to ARDS requiring invasive mechanical ventilation and extracorporeal membrane oxygenation. A kidney transplanted patient infected with SARS CoV-2 infection showed a mild disease despite immune suppression. It is possible that Immunosuppression can "be protective" as the cytokine storm is an important factor in the disease story. Despite the good outcome reported in the present case report, is remains of vital importance the solid organ transplant patients use precautions in order to avoid the infection.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Glomerulonefritis por IGA/complicaciones , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Betacoronavirus , Ceftriaxona/administración & dosificación , Citocinas/metabolismo , Glomerulonefritis por IGA/cirugía , Humanos , Inmunosupresión/efectos adversos , Inmunosupresión/métodos , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Pandemias , Tacrolimus/administración & dosificación , Resultado del Tratamiento
11.
Am J Transplant ; 20(7): 1916-1921, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-210165

RESUMEN

Over 1 000 000 cases of coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide outbreak began. Not enough data on infected solid organ transplant (SOT) recipients are available, especially data about the management of immunosuppressants. We report two cases of COVID-19 in two transplant recipients, with different treatments and prognoses. The first patient received liver transplantation due to hepatitis B virus-related hepatocellular carcinoma and was confirmed to have COVID-19 9 days later. Following a treatment regimen consisting of discontinued immunosuppressant use and low-dose methylprednisolone-based therapy, the patient developed acute rejection but eventually recovered. The other patient had undergone a renal transplant from a living-related donor 17 years ago, and was admitted to the hospital because of persistent fever. This patient was also diagnosed with COVID-19. His treatment regimen consisted of reduced immunosuppressant use. No signs of rejection were observed during the regimen. In the end, the patient successfully recovered from COVID-19. These effectively treated cases can provide a basis for immunosuppressant management of COVID-19-positive SOT recipients.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Inmunosupresores/uso terapéutico , Trasplante de Órganos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Receptores de Trasplantes , Adulto , Betacoronavirus , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/cirugía , Hepatitis B/complicaciones , Hepatitis B/cirugía , Virus de la Hepatitis B , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Pandemias , Pronóstico , Resultado del Tratamiento
13.
Am J Transplant ; 20(8): 2269-2275, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-125542

RESUMEN

The fatality of novel coronavirus disease 2019 (COVID-19) is precipitously increased in patients with underlying comorbidities or elderly people. Kidney transplant (KT) recipients are one of the vulnerable populations for infection. COVID-19 infection in KT recipients might be a complicated and awkward situation, but there has been a lack of reports concerning this group. Herein, we demonstrated two distinct cases with different clinical progress. The first case was a 36-year-old man who underwent KT 3 years ago. He was diagnosed with COVID-19 expressing relevant symptoms. Following administration of lopinavir/ritonavir and hydroxychloroquine with reduced immunosuppressant, he recovered from COVID-19. However, the unexpected fluctuations in tacrolimus trough levels needed to be managed because of drug-to-drug interaction. The second case was developed in a 56-year-old man without any symptoms. He received a second KT from an ABO-incompatible donor 8 years ago. He was diagnosed with COVID-19 by screening due to exposure history. During the hospitalization period, the chest infiltrative lesion showed a wax and wane, but he successfully recovered by administration of hydroxychloroquine with azithromycin. These apparently different cases suggest that assertive screening and management could improve the clinical course. In addition, antiviral agents should be used cautiously, especially in patients on calcineurin inhibitors.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Receptores de Trasplantes , Adulto , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , Betacoronavirus , Inhibidores de la Calcineurina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Combinación de Medicamentos , Interacciones Farmacológicas , Humanos , Hidroxicloroquina/uso terapéutico , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/cirugía , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Ritonavir/uso terapéutico , Tacrolimus/uso terapéutico
14.
Am J Transplant ; 20(7): 1896-1901, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-125541

RESUMEN

The current coronavirus disease 2019 (COVID-19) pandemic requires extra attention for immunocompromised patients, including solid organ transplant recipients. We report on a case of a 35-year-old renal transplant recipient who suffered from a severe COVID-19 pneumonia. The clinical course was complicated by extreme overexposure to the mammalian target of rapamycin inhibitor everolimus, following coadministration of chloroquine and lopinavir/ritonavir therapy. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based COVID-19 therapy and concurrent pressure for exploration of experimental pharmacological treatment options. However, the risk-benefit balance of experimental or off-label therapy may be weighed differently in organ transplant recipients than in otherwise healthy COVID-19 patients, owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy. With this case report, we aimed to achieve increased awareness and improved management of drug-drug interactions associated with the various treatment options for COVID-19 in renal transplant patients.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Everolimus/farmacocinética , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Receptores de Trasplantes , Adulto , Antivirales/administración & dosificación , Antivirales/farmacocinética , Betacoronavirus , Cloroquina/administración & dosificación , Cloroquina/farmacocinética , Combinación de Medicamentos , Interacciones Farmacológicas , Everolimus/administración & dosificación , Humanos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Inmunosupresores/farmacocinética , Fallo Renal Crónico/cirugía , Lopinavir/administración & dosificación , Lopinavir/farmacocinética , Masculino , Países Bajos , Pandemias , Radiografía Torácica , Ritonavir/administración & dosificación , Ritonavir/farmacocinética , Resultado del Tratamiento
15.
Am J Transplant ; 20(7): 1885-1890, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-116579

RESUMEN

With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Inmunosupresión/métodos , Neumonía Viral/complicaciones , Receptores de Trasplantes , Anciano , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/cirugía , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Hospitalización , Humanos , Inmunosupresión/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Trasplante de Hígado , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Estados Unidos/epidemiología , Poblaciones Vulnerables , Washingtón
16.
Am J Transplant ; 20(7): 1902-1906, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-108811

RESUMEN

Coronavirus disease 2019 (COVID-19) pneumonia has been poorly reported in solid organ transplanted patients; prognosis is uncertain and best management unclear. We describe the case of a 61-year-old kidney transplant recipient with several comorbidities who was hospitalized and later received a diagnosis of COVID-19 pneumonia; the infection was successfully managed with the use of hydroxychloroquine and a single administration of tocilizumab, after immunosuppression reduction; the patient did not require mechanical ventilation. During the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, transplant clinicians should be readily informed about new cases of COVID-19 pneumonia in solid organ transplant recipients, with focus on therapeutic strategies employed and their outcome.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Infecciones por Coronavirus/terapia , Hidroxicloroquina/administración & dosificación , Inmunosupresores/administración & dosificación , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Nefritis Intersticial/complicaciones , Neumonía Viral/terapia , Antivirales/administración & dosificación , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Nefritis Intersticial/cirugía , Pandemias , Neumonía Viral/complicaciones , Respiración Artificial , Medición de Riesgo , Resultado del Tratamiento
17.
Am J Transplant ; 20(7): 1879-1881, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-101378

RESUMEN

Coronavirus Disease 2019 (COVID-19) has become a pandemic since March 2020. We describe here 2 cases of COVID-19 infection in a posttransplant setting. First one is a 59-year-old renal transplant recipient; the second is a 51-year-old allogeneic bone marrow transplant recipient. Both patients were on immunosuppressant therapy and had stable graft function before COVID-19 infection. After the diagnosis of COVID-19, immunosuppressive agents were discontinued and methylprednisolone with prophylactic antibiotics were initiated, however, the lung injury progressed. The T cells were extremely low in both patients after infection. Both patients died despite the maximal mechanical ventilatory support. Therefore, the prognosis of COVID-19 pneumonia following transplantation is not optimistic and remains guarded. Lower T cell count may be a surrogate for poor outcome.


Asunto(s)
Trasplante de Médula Ósea , Infecciones por Coronavirus/complicaciones , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Leucemia Mieloide Aguda/complicaciones , Neumonía Viral/complicaciones , Receptores de Trasplantes , Antibacterianos/administración & dosificación , Infecciones Bacterianas/complicaciones , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Infección Hospitalaria/complicaciones , Resultado Fatal , Humanos , Inmunosupresores/administración & dosificación , Fallo Renal Crónico/cirugía , Leucemia Mieloide Aguda/terapia , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Complicaciones Posoperatorias , Pronóstico , Respiración Artificial , Linfocitos T/citología
18.
Am J Transplant ; 20(7): 1911-1915, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-101339

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly infecting people worldwide, resulting in the infectious disease coronavirus disease 19 (COVID-19) that has been declared a pandemic. Much remains unknown about COVID-19, including its effects on solid organ transplant (SOT) recipients. Given their immunosuppressed state, SOT recipients are presumed to be at high risk of complications with viral infections such as SARS-CoV-2. Limited case reports in single SOT recipients, however, have not suggested a particularly severe course in this population. In this report, we present a dual-organ (heart/kidney) transplant recipient who was found to have COVID-19 and, despite the presence of a number of risk factors for poor outcomes, had a relatively mild clinical course.


Asunto(s)
Cardiomiopatía Dilatada/complicaciones , Infecciones por Coronavirus/diagnóstico , Trasplante de Corazón , Fallo Renal Crónico/complicaciones , Trasplante de Riñón , Neumonía Viral/diagnóstico , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/análogos & derivados , Adulto , Alanina/administración & dosificación , Alanina/análogos & derivados , Betacoronavirus , Cardiomiopatía Dilatada/cirugía , Infecciones por Coronavirus/complicaciones , Humanos , Hidroxicloroquina/administración & dosificación , Huésped Inmunocomprometido , Inmunosupresión/efectos adversos , Inmunosupresores/efectos adversos , Fallo Renal Crónico/cirugía , Masculino , Pandemias , Neumonía Viral/complicaciones , Radiografía Torácica , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
19.
Transpl Infect Dis ; 22(4): e13296, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-73020

RESUMEN

Coronavirus Disease 2019 (COVID-19) is currently a pandemic with a mortality rate of 1%-6% in the general population. However, the mortality rate seems to be significantly higher in elderly patients, especially those hospitalized with comorbidities, such as hypertension, diabetes, or coronary artery diseases. Because viral diseases may have atypical presentations in immunosuppressed patients, the course of the disease in the transplant patient population is unknown. Hence, the management of these patients with COVID-19 is an area of interest, and a unique approach is warranted. Here, we report the clinical features and our treatment approach for a kidney transplant patient with a diagnosis of COVID-19. We believe that screening protocols for SARS-Cov-2 should be re-evaluated in patients with solid-organ transplants.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Rechazo de Injerto/prevención & control , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Neumonía Viral/tratamiento farmacológico , Adulto , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Tos/etiología , Manejo de la Enfermedad , Femenino , Fiebre/etiología , Glucocorticoides , Humanos , Fallo Renal Crónico/cirugía , Nefritis Lúpica/cirugía , Oseltamivir/uso terapéutico , Pandemias , Neumonía Viral/complicaciones , Prednisona/uso terapéutico , Índice de Severidad de la Enfermedad , Tacrolimus/uso terapéutico
20.
Transpl Infect Dis ; 22(4): e13286, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: covidwho-47858

RESUMEN

During the novel coronavirus pandemic, organ transplant recipients represent a frail susceptible category due to long-term immunosuppressive therapy. For this reason, clinical manifestations may differ from general population and different treatment approaches may be needed. We present the case of a 36-year-old kidney-transplanted woman affected by Senior-Loken syndrome diagnosed with COVID-19 pneumonia after a contact with her positive mother. Initial symptoms were fatigue, dry cough, and coryza; she never had fever nor oxygen supplementation. Hydroxychloroquine and lopinavir/ritonavir were started, and the antiviral drug was replaced with darunavir/cobicistat after 2 days for diarrhea. Immunosuppressant levels were closely monitored, and we observed very high tacrolimus trough levels despite initial dose reduction. The patient was left with steroid therapy alone. The peculiarity of clinical presentation and the management difficulties represent the flagship of our case report. We stress the need for guidelines in transplant recipients with COVID-19 infection with particular regard to the management of therapy.


Asunto(s)
Antivirales/efectos adversos , Infecciones por Coronavirus/tratamiento farmacológico , Inhibidores del Citocromo P-450 CYP3A/efectos adversos , Rechazo de Injerto/prevención & control , Inmunosupresores/efectos adversos , Trasplante de Riñón , Lopinavir/efectos adversos , Neumonía Viral/tratamiento farmacológico , Ritonavir/efectos adversos , Tacrolimus/efectos adversos , Adulto , Antivirales/uso terapéutico , Betacoronavirus , Proteína C-Reactiva/inmunología , Ciliopatías/complicaciones , Cobicistat/uso terapéutico , Resfriado Común/etiología , Resfriado Común/fisiopatología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Tos/etiología , Tos/fisiopatología , Darunavir/uso terapéutico , Deprescripciones , Combinación de Medicamentos , Interacciones Farmacológicas , Inhibidores Enzimáticos/uso terapéutico , Fatiga/etiología , Fatiga/fisiopatología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Huésped Inmunocomprometido/inmunología , Interleucina-10/inmunología , Interleucina-1beta/inmunología , Interleucina-6/inmunología , Interleucina-8/inmunología , Enfermedades Renales Quísticas/complicaciones , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Amaurosis Congénita de Leber/complicaciones , Metilprednisolona/uso terapéutico , Atrofias Ópticas Hereditarias/complicaciones , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología , Índice de Severidad de la Enfermedad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA