Current practices for management and treatment of covid-19 in immunocompromised adults: A survey of institutions

ABSTRACT

Purpose: The optimal testing strategy for solid organ transplantation (SOT) donor and recipient evaluation, as well as treatment for COVID-19 is unknown. We assessed the management strategy of COVID-19 within the West Coast Transplant Infectious Disease group. Methods: A survey assessing strategies for COVID-19 management was sent to 11 Transplant Infectious Diseases providers from 8 centers. Results: For both living and deceased donor clearance, 81.8% (n=9) providers utilize one negative PCR within 72 hours of transplantation. However, when a living donor tests positive for SARS-COV-2, 36.4% (n=4) will require two negative PCR tests >24 hours apart for donor clearance, with 90.9% (n=10) requiring at least a 28-day wait period prior to retesting. Amongst providers caring for lung transplant recipients, 77.7% (7/9) utilized negative PCR from donor BAL as part of pre-transplant evaluation. For transplant candidates, all providers required both the absence of COVID-19 symptoms with only one negative PCR test. In candidates that tested positive for SARS-COV-2, 54.5% (n=6) required at least two negative PCRs prior to transplantation. For positive candidates, 63.6% (n=7) considered re-testing for PCR negativity at 20 days. When a transplant recipient tested positive for SARSCoV-2, all providers would reduce antimetabolites and utilized dexamethasone for patients requiring oxygen therapy. Remdesivir was prescribed by all providers with variability in the timing of administration. Conclusions: Management and treatment of COVID-19 for SOT donors, candidates, and recipients was heterogeneous. While all providers require at least one negative COVID-19 test as both donor and recipient evaluation prior to transplantation, the number of negative tests sent varied amongst providers, geographical region, and clinical scenario. The significant diversity of COVID-19 management strategies for immunocompromised adults seen in this study highlights the further need for studies defining the optimal management of COVID-19.