Clinical characteristics and management of a liver transplanted patient admitted with SARS-CoV-2 infection

Gottardi, Andrea De; Fratila, Corneliu; Bertoli, Raffaela; Cerny, Andreas; Magenta, Lorenzo; Gianella, Pietro; Majno‐Hurst, Pietro; Ceschi, Alessandro; Vanini, Gianluca; Bernasconi, Enos

doi:10.1016/j.clinre.2020.05.014

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…1 . Most included studies were case reports (n=89) [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ...…”

Section: Resultsunclassified

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Quante

Brake

Tolios

et al. 2021

Transplantation Proceedings

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Background : The SARS-CoV-2 pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, an inexorable number of case reports, case series and ultimately various systematic reviews have been published reporting on morbidity and mortality risk of SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even the expert reader. Methods : We performed a structured literature review comprising electronic databases, transplant journals and included literature from previous systematic reviews covering the entire year 2020. From 164 included articles we identified 3451 cases of SARS-CoV-2 infected SOT recipients. Results : Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions (ICU) in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after COVID-19 was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT patients. Conclusions : COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT patients diseased with COVID-19.

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Section: Resultsunclassified

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Quante

Brake

Tolios

et al. 2021

Transplantation Proceedings

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Mycophenolate mofetil/sirolimus

2021

Reactions Weekly

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Mycophenolate mofetil/sirolimus COVID-19 infection and severe interstitial pneumonia: case reportA 62-year-old man developed COVID-19 infection and severe interstitial pneumonia during immunosuppressive treatment with sirolimus and mycophenolate mofetil [duration of treatments to reaction onsets not stated].The man was admitted to an emergency department with a 3-day history of cough and fever on 04 March 2020. His history was significant for hepatitis C virus infection genotype 1 and non-alcoholic steatohepatitis (NASH)-related cirrhosis with hepatocellular carcinoma, for which he had undergone liver transplantation four years prior. He was overweight, and also had type 2 diabetes, arterial hypertension and dyslipidaemia. He had been receiving immunosuppressive treatment with sirolimus 1 mg/day and mycophenolate mofetil [not all dosages stated; routes not stated] along with other comedications. At admission, his body temperature was 38.5°C, HR was 92 /minute and BP was 125/70mm Hg. Laboratory investigations were as follows: CRP 18 mg/L, Hb 133 g/L, glucose 6.3 mM and leucocytes 5.1 G/L with increased levels of ALT. PCR showed positive results for SARS-CoV-2 infection, confirming diagnosis of COVID-19 infection secondary to the immunosuppressive treatment. Pulmonary low-dose CT scan showed bilateral sub-pleural ground-glass infiltrates. Arterial blood gas analysis revealed RR of 20 /min, oxygen saturation was 93%, decreased pO2 and bicarbonate levels.The man was treated with off-label lopinavir/ritonavir 200/50mg twice a day and hydroxychloroquine 200mg twice a day. He also received empiric treatment with cefepime. The dose of sirolimus was decreased by 50% as there was risk of interaction with ritonavir, and sirolimus plasma levels were daily monitored to maintain them between 4-8 µg/L. His amlodipine and rosuvastatin treatments were discontinued. His fever persisted, and he experienced mild deterioration of respiratory function. His pO2 was 8.1 kPa, CRP levels were elevated and he experienced diarrhoea. Progression of the pulmonary infiltrates was confirmed on CT scan. Severe interstitial pneumonia was suspected, and cefepime was switched to meropenem. All blood cultures were found to be negative. During the next 3 days, his fever resolved, oxygen saturation increased and CRP level decreased. A significant improvement in his general condition was noted, and treatment with lopinavir/ritonavir and hydroxychloroquine was ceased. His clinical recovery continued. Sirolimus dose was increased back to 1 mg/day and the transaminase levels remained within the normal range.

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COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature

Raja

Mendoza

Villavicencio

et al. 2021

Transplantation Reviews

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Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection from January 1 st t October 9 th , 2020. Pooled incidence of symptoms, treatments and outcomes were assessed. Two hundred and fifteen studies were included for systematic review and 60 for meta-analysis. We identified 2,772 unique SOT recipients including 1,500 kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms were fever and cough in 70.2% and 63.8% respectively. Majority (81%) required hospital admission. Immunosuppressive medications, especially antimetabolites, were decreased in 76.2%. Hydroxychloroquine and interleukin six antagonists were administered in59.5% and 14.9% respectively, while only few patients received remdesivir and convalescent plasma. Intensive care unit admission was 29% from amongst hospitalized patients. Only few studies reported secondary infections. Overall mortality was 18.6%. Our analysis shows a high incidence of hospital admission in SOT recipients with SARS-CoV-2 infection. As management of SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients should be assessed in future studies.

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Clinical characteristics and management of a liver transplanted patient admitted with SARS-CoV-2 infection

Cited by 4 publications

References 19 publications

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Mycophenolate mofetil/sirolimus

COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature

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