Non-Lung Solid Organ Transplantation From SARS-CoV-2-Positive Donors to Uninfected Recipients.

BACKGROUND: There is a paucity of evidence on the risk of donor-recipient transmission of the SARS-CoV-2 in solid organ transplant recipients. Initial impressions suggest non-lung solid organs may be safely transplanted from SARS-CoV-2-positive donors without risk of viral transmission. METHODS: We reviewed clinical results of transplants in which SARS-CoV-2-negative recipients received non-lung solid organs from SARS-CoV-2-positive donors at a single transplant center. No prisoners were used in this study, and participants were neither coerced nor paid. The manuscript was created in compliance with the Helsinki Congress and the Declaration of Istanbul. RESULTS: Between June 2021 and January 2023, we transplanted 26 solid organs, including 13 kidneys, 8 livers, 3 hearts, and 1 simultaneous heart and kidney, from 23 SARS-CoV-2-positive donors into 25 SARS-CoV-2 negative recipients. Two of the recipients had a positive SARS-CoV-2 real-time polymerase chain reaction after transplantation, but otherwise, patients had no SARS-CoV-2-related complications, and all patients to date are alive with excellent allograft function. CONCLUSION: Transplantation of non-lung solid organs from SARS-CoV-2-positive donors into uninfected recipients can be safely performed without adverse effects from SARS-CoV-2.

Incidental COVID-19 in a heart-kidney transplant recipient with malnutrition and recurrent infections: Implications for the SARS-CoV-2 immune response.

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status, and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.

The utility of newly derived Doppler echocardiographic variables in the diagnosis and management of patients with heart failure.

Doppler echocardiography, because of its noninvasive nature, is an ideal tool to evaluate patients with heart failure (HF), offering the potential to improve early identification and management of these patients. Although traditional Doppler indices have allowed characterization of diastolic filling abnormalities associated with various HF states, important limitations are recognized. More refined Doppler techniques such as analysis of color M-mode flow propagation velocity, tissue Doppler imaging, and strain parameters can add to the ability of the noninvasive laboratory to improve the identification and management of this group of patients. These newer techniques as well as the traditional Doppler assessment of transmitral left ventricular inflow and pulmonary venous inflow velocities are reviewed as methods to improve the diagnosis and management of patients with HF.

Comparison of survival and other complications after heart transplantation in patients taking amiodarone before surgery versus those not taking amiodarone.

Concern exists regarding preoperative amiodarone use and complications occurring after heart transplantation (HT). During a 10-year period of performing HT, we found that patients treated with amiodarone before undergoing HT had decreased overall survival, required longer periods of ventilatory support, and were at increased risk for significant bleeding complications. These findings raise further concern about the use of amiodarone treatment in patients with heart failure before undergoing HT.

Management issues for patients with coronary artery disease and heart failure.

Despite recent favorable trends in survival, heart failure remains a highly fatal disease. Improvements in the prevention of early death from coronary artery disease, along with an aging population, have resulted in an increased prevalence for heart failure in the United States. In the management of patients with heart failure secondary to coronary artery disease, the relative efficacy of invasive therapies such as coronary revascularization, surgical left ventricle remodeling, internal cardiac defibrillator implantation, cardioverter resynchronization therapy, mechanical ventricular assist, and cardiac transplantation need to be considered. Clinical studies examining these important treatment options are reviewed in order to better define the optimal management strategy for this challenging population of patients.