Coronavirus disease 2019 in solid organ transplant recipients in the setting of proactive screening and contact tracing of Qatar

Abstract

Background: Clinical data on Coronavirus Disease 2019 (COVID-19) in solid organ transplant (SOT) recipients are limited. We herein report the initial clinical experience with COVID-19 in SOT recipients in Qatar. Methods: All SOT recipients with laboratory-confirmed COVID-19 up to May 23, 2020 were included. Demographic and clinical data were extracted retrospectively from the hospital’s electronic health records. Categorical data are presented as frequency and percentages, while continuous variables are summarized as medians and ranges. Results: Twenty-four SOT recipients with COVID-19 were identified (kidney 16, liver 6, heart 1, and liver and kidney 1). Organ transplantation preceded COVID-19 by a median of 60 months (range 1.7–184). The median age was 57 years (range 24–72), and 9 (37.5%) transplant recipients were females. Five (21%) asymptomatic patients were diagnosed through proactive screening. For the rest, fever (15/19) and cough (13/19) were the most frequent presenting symptoms. Five (20.8%) patients required invasive mechanical ventilation in the intensive care unit (ICU). Eleven (46%) patients developed acute kidney injury, including three in association with drug-drug interactions involving investigational COVID-19 therapies. Maintenance immunosuppressive therapy was modified in 18 (75%) patients, but systemic corticosteroids were not discontinued in any. After a median follow-up of 226 days (26–272), 20 (83.3%) patients had been discharged home, 2 (8.3%) were still hospitalized, 1 (4.2%) was still in the ICU, and 1 (4.2%) had died. Conclusions: Our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not uniformly worse than those in the general population. The results require confirmation in large, international cohorts.

The effects of COVID‐19 on pediatric and adult solid organ transplant recipients and the emergence of telehealth

“…Overall, obesity was found to be present in 21% (95% CI: 15% to 28%) of the patients (Figure 2) and hypertension in 74% (95% CI: 66% to 80%) (Figure 3) of the patients. Additionally, investigating comorbidities, seven studies 12–18 reported pooled proportion of CAD of 18% (95% CI: 6% to 43%) (Figure 4); 10 studies 12,15,16,19–25 reported pooled proportion of CKD patients of 52% (95% CI: 40% to 63%; Figure 5) and 23 studies 12–34 reported a pooled proportion of patients with diabetes of 44% (95% CI: 37% to 51%; Figure 6). We identified 30 studies from our included studies to analyze all‐cause mortality.…”

“…Acute kidney injury (AKI) was reported in 13 studies, and the pooled AKI rate was 31% (95% CI: 26% to 37%) 12,15,17,21,26–29,32,36,39,41,42 [Figure 9]. Bajaut's plot showed study by Hadi Y et al unduly influenced heterogeneity and pooled estimates.…”

“…We identified 30 studies from our included studies to analyze allcause mortality. The pooled mortality was 17% (95% CI: 14% to 20%, I 2 = 96%); however, there was a significant heterogeneity and On performing subgroup analysis based on the type of transplant recipients (kidney, liver, heart, lung, or mixed), the mortality in kidney transplant recipients was 25% (95% CI: 0.18; 0.35; five studies), 13,14,35,36 14% (95% CI: 0.11; 0.18; 22 studies ) 12,15,16,18,19,21,[23][24][25][26][27][29][30][31][32][33][34][37][38][39][40][41] in mixed SOTRs; 20% (95% CI: 0.13; 0.29; one study) 28 in liver transplant recipients; 27% (95% CI: 0.13; 0.47; one study) 20 in heart transplant recipients; and 8% (95% CI: 0.01; 0.3; one study) 22 in lung transplant recipients. There was considerable heterogeneity (I 2 = 90%), and the test for subgroup difference was significant (Figure 7).…”

“…Acute kidney injury (AKI) was reported in 13 studies, and the pooled AKI rate was 31% (95% CI: 26% to 37%) 12,15,17,21,[26][27][28][29]32,36,39,41,42 [Figure 9]. Bajaut's plot showed F I G U R E 1 PRISMA flow diagram for COVID-19 involvement in solid organ transplant recipients.…”

“…Visual inspection of the funnel plot for publication bias showed asymmetry. Upon subgroup analysis based on the type of transplant recipients (kidney, liver, heart, lung, or mixed), the reported proportion of patients with AKI was 28% (95% CI: 0.22 to 0.36; 10 studies; I 2 = 92%) in studies reporting mixed SO TRs 12,15,17,21,26,27,29,32,39,41 ; 39% (95%CI: 0.35 to 0.44; two studies; I 2 = 0%) in kidney transplant recipients 36,42 and 31% (95% CI: 0.26 to 0.37; one study), 28 and the test for subgroup difference was significant (Figure 10).…”