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2.
Am J Transplant ; 20(10): 2933-2937, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-843550

RESUMEN

Coronavirus disease 2019 (COVID-19) has been declared pandemic since March 2020. In Europe, Italy was the first nation affected by this infection. We report anamnestic data, clinical features, and therapeutic management of 2 lung transplant recipients with confirmed COVID-19 pneumonia. Both patients were in good clinical condition before the infection and were receiving immunosuppression with calcineurin inhibitors (CNI), mycophenolate mofetil, and corticosteroids. Whereas mycophenolate mofetil was withdrawn in both cases, CNI were suspended only in the second patient. The first patient always maintained excellent oxygen saturation throughout hospitalization with no need for additional oxygen therapy. He was discharged with a satisfactory pulmonary function and a complete resolution of radiological and clinical findings. However, at discharge SARS-CoV-2 RNA could still be detected in the nasopharyngeal swab and in the stools. The second patient required mechanical ventilation, had a progressive deterioration of his clinical conditions, and had a fatal outcome. Further insight into SARS-CoV-2 infection is eagerly awaited to improve the outcome of transplant recipients affected by COVID-19 pneumonia.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Trasplante de Pulmón/métodos , Neumonía Viral/diagnóstico , Receptores de Trasplantes , Anciano , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Fibrosis Quística/cirugía , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/terapia , Neumonía Viral/transmisión , Periodo Posoperatorio , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Respiración Artificial , Tomografía Computarizada por Rayos X
5.
BMC Infect Dis ; 20(1): 707, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: covidwho-795366

RESUMEN

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. Data on the clinical picture of transplant recipients and management of the anti-rejection immunosuppressive therapy on COVID-19 infection are lacking. CASE PRESENTATION: We report two cases of COVID-19 infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stable clinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reduced immunosuppression therapy and finally recovered. CONCLUSIONS: We report COVID-19 infection in two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference value for treating such patients.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Trasplante de Riñón , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Receptores de Trasplantes , Resultado del Tratamiento
8.
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
9.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 495-500, 2020 May 28.
Artículo en Inglés, Chino | MEDLINE | ID: covidwho-745315

RESUMEN

OBJECTIVES: To summarize the emergency management of the kidney transplantation for a large tertiary first-class hospital in response to the epidemic of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of inpatients in the Department of Kidney Transplantation from January 24, 2020 to February 29, 2020 were retrospectively analyzed. Since the outbreak of COVID-19, we conducted telephone, Wechat follow-up, and online education for kidney transplant recipients and patients on waiting-list for kidney transplantation one by one. We also strictly screened for COVID-19 in outpatients. To guarantee the security of medical staff and recipients and to reduce the transmission risk of COVID-19, we have made detailed approaches to prevent COVID-19, which mainly included 6 aspects of preventive approaches, such as kidney transplant clinic, kidney transplant ward, patients on waiting-list for kidney transplantation, kidney transplant operation, medical staff self-protection, and postoperative follow-up of kidney transplant recipients. RESULTS: There were altogether 47 inpatients which included 20 recipients who had just received kidney transplantation in the meantime, 2 577 kidney transplant recipients, 1 689 patients on waiting-list for kidney transplantation, and 794 outpatients in our hospital. No case of COVID-19 occurred in this period. CONCLUSIONS: Through strictly implementing proactive and preventive approaches, we avoid the occurrence of COVID-19 in carrying out kidney transplantation in the epidemic period.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Trasplante de Riñón , Neumonía Viral/epidemiología , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Estudios Retrospectivos , Centros de Atención Terciaria , Receptores de Trasplantes , Listas de Espera
11.
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
12.
J Gastrointestin Liver Dis ; 29(3): 470, 2020 09 09.
Artículo en Inglés | MEDLINE | ID: covidwho-729795
13.
Am J Case Rep ; 21: e926464, 2020 Aug 16.
Artículo en Inglés | MEDLINE | ID: covidwho-721634

RESUMEN

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Infecciones por Coronavirus/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Neumonía Bacteriana/microbiología , Neumonía Viral/complicaciones , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Betacoronavirus , Deterioro Clínico , Coinfección , Infecciones por Coronavirus/tratamiento farmacológico , Resultado Fatal , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Stenotrophomonas maltophilia , Receptores de Trasplantes , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación
15.
J Investig Med High Impact Case Rep ; 8: 2324709620949307, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-708945

RESUMEN

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/fisiopatología , Trasplante de Riñón/efectos adversos , Neumonía Viral/fisiopatología , Infecciones por Coronavirus/complicaciones , Diarrea/etiología , Fatiga/etiología , Femenino , Humanos , Persona de Mediana Edad , Trasplante de Órganos , Pandemias , Neumonía Viral/complicaciones , Receptores de Trasplantes
16.
Orv Hetil ; 161(32): 1310-1321, 2020 08.
Artículo en Húngaro | MEDLINE | ID: covidwho-706828

RESUMEN

Due to the COVID-19 pandemic caused by infection with the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant medicine also had to face a new, hitherto unknown challenge. To be prepared for any possibility, we consider it important to summarize the current knowledge regarding COVID-19 of liver and kidney transplant patients. Very early reports from Spanish and French registry recorded fatality rates of 18.6% and 13%, respectively, in renal patients which suggests a moderately worse outcome compared to the general population. In patients with positive PCR test but not showing clinical signs, the reduction of immunosuppression is not advised. In the case of gastrointestinal or respiratory signs with fever, the discontinuation of mycophenolate or mTOR inhibitors is recommended with decrease of the trough levels of calcineurin inhibitors to the lowest effective limit. Stop (kidney transplanted patients) or decrease (liver transplanted patients) immunosuppression and maintain corticosteroids when pulmonal injury develops and consider anti-IL1 and anti-IL6 monoclonal antibody use when hyperinflammatory syndrome is evolving. No proven effective treatment for SARS-CoV-2 exists currently. The use of lopinavir/ritonavir should be avoided because of the severe drug interaction with calcineurin inhibitors. The efficacy and tolerability of hidroxychloroquin remains to be also questionable; enroll patients into clinical trial with remdesivir or favipiravir if available. COVID-19 is characterized by virus-induced endothelial dysfunction, procoagulant state and renin-angiotensin-aldosteron system imbalance. Early thromboprofilaxis combination with low-molecular-weight heparin and low-dose aspirin is strongly recommended with the maintenance of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II-receptor blocker (ARB) therapy when they were prescribed earlier. Orv Hetil. 2020; 161(32): 1310-1321.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Trasplante de Riñón , Trasplante de Hígado , Neumonía Viral/complicaciones , Receptores de Trasplantes , Corticoesteroides/uso terapéutico , Betacoronavirus , Inhibidores de la Calcineurina/efectos adversos , Contraindicaciones de los Medicamentos , Combinación de Medicamentos , Interacciones Farmacológicas , Humanos , Inmunosupresión , Lopinavir/efectos adversos , Pandemias , Ritonavir/efectos adversos
17.
Sci Adv ; 6(30): eaba6884, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-706017

RESUMEN

More than 1050 clinical trials are registered at FDA.gov that explore multipotent mesenchymal stromal cells (MSCs) for nearly every clinical application imaginable, including neurodegenerative and cardiac disorders, perianal fistulas, graft-versus-host disease, COVID-19, and cancer. Several companies have or are in the process of commercializing MSC-based therapies. However, most of the clinical-stage MSC therapies have been unable to meet primary efficacy end points. The innate therapeutic functions of MSCs administered to humans are not as robust as demonstrated in preclinical studies, and in general, the translation of cell-based therapy is impaired by a myriad of steps that introduce heterogeneity. In this review, we discuss the major clinical challenges with MSC therapies, the details of these challenges, and the potential bioengineering approaches that leverage the unique biology of MSCs to overcome the challenges and achieve more potent and versatile therapies.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/metabolismo , Neumonía Viral/terapia , Técnicas de Cultivo Celular por Lotes/métodos , Reactores Biológicos , Infecciones por Coronavirus/virología , Enfermedad Injerto contra Huésped/terapia , Humanos , Ingeniería Metabólica/métodos , Pandemias , Neumonía Viral/virología , Receptores de Trasplantes
18.
BMJ Case Rep ; 13(7)2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: covidwho-657710

RESUMEN

Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Yet, here we describe a remarkably mild case of COVID-19 in a 62-year-old female who had a kidney transplantation 10 years earlier due to autosomal dominant polycystic kidney disease. The patient was admitted for 1 day; immunosuppressive therapy with tacrolimus and low-dose prednisolone was continued; and the patient recovered successfully without the use of antiviral agents or oxygen therapy. The case demonstrates that kidney transplant recipients are not necessarily severely affected by COVID-19. Withdrawal of immunosuppressive therapy could be associated with poorer outcomes and should not be implemented thoughtlessly.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Inmunosupresión/efectos adversos , Trasplante de Riñón/efectos adversos , Neumonía Viral/diagnóstico , Receptores de Trasplantes/estadística & datos numéricos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Femenino , Glucocorticoides/uso terapéutico , Hospitalización , Humanos , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Prednisolona/uso terapéutico , Tacrolimus/uso terapéutico , Resultado del Tratamiento
19.
Nephrol Dial Transplant ; 35(7): 1250-1261, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: covidwho-652871

RESUMEN

BACKGROUND: Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies. METHODS: We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate. RESULTS: Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients. CONCLUSIONS: Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Rechazo de Injerto/terapia , Hidroxicloroquina/uso terapéutico , Inmunosupresión/métodos , Trasplante de Riñón , Ácido Micofenólico/uso terapéutico , Neumonía Viral/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Aloinjertos , Antimaláricos/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Inhibidores Enzimáticos/uso terapéutico , Femenino , Rechazo de Injerto/complicaciones , Rechazo de Injerto/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Estudios Retrospectivos , Receptores de Trasplantes
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