Covid-19 and Kidney Transplantation

Akalin, Enver; Azzi, Yorg; Bartash, Rachel; Seethamraju, Harish; Parides, Michael K.; Hemmige, Vagish; Ross, Michael J.; Forest, Sylvain; Goldstein, D. Yitzchak; Ajaimy, Maria; Liriano‐Ward, Luz; Pynadath, Cindy; Loarte, P. del Valle; Nandigam, Purna B.; Graham, Jay A.; Le, Marie; Rocca, Juan P.; Kinkhabwala, Milan

doi:10.1056/nejmc2011117

Cited by 707 publications

(1,009 citation statements)

References 4 publications

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“…We decided to assess this variable as a primary endpoint due to its higher speci city in detecting more in ammatory patients. This contrasts with previous data [21][22][23][24][25] about immunosuppression, but differences might reside in the grade of immunosuppression, being less severe in our cohort. To delve into a possible condition explaining these results, we further differentiated IS patients between those with an AD and those with other diseases (such as cancer or an organ transplant).…”

Section: Discussioncontrasting

confidence: 99%

“…A population-based study in China evaluated cancer patients with recent surgery or chemotherapy, and found a higher risk of severe events 20 . In addition, recent data about patients with moderate or severe immunosuppression associated to haematologic malignancy 21,22 and solid organ transplant recipients 23,24 detected higher death ratios compared to general population. In line with these results, a large population-based study with over 17 million subjects developed in UK found a higher mortality among organ transplant, immunosuppression, haematological malignancies, and several autoimmune diseases 25 .…”

Section: Discussionmentioning

confidence: 98%

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Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19.

Monreal

Maza

Gullón

et al. 2020

Preprint

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BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread rapidly worldwide. The role of immunosuppression among COVID-19 patients has not been elucidated and management may be challenging. OBJECTIVE: To assess differences in severe outcomes of hospitalized patients with COVID-19 according to immune system state. DESIGN: Retrospective single-center observational study with confirmed COVID-19 patients admitted to Hospital Universitario Ramón y Cajal from March 18, 2020 to April 04, 2020. The final date of follow-up was April 09, 2020.PARTICIPANTS: Confirmed COVID-19 patients. MAIN MEASURES: The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. KEY RESULTS: Of 138 patients included, 27 (19.6%) were immunosuppressed (IS), with 95 (68.8%) male patients and a median (Q1, Q3) age of 68 (54–78) years. Among the baseline characteristics, no relevant or significant differences were observed between IS and non-immunosuppressed (non-IS) patients, detecting a non-severe immunosupression among IS. A significantly lower proportion of IS patients (22.2% [95%CI, 9.8–43.0%]) compared to non-IS patients (49.5% [95%CI, 40.2–58.9%]) developed moderate-severe ARDS, in both unadjusted (OR 0.29 [95%CI, 0.11–0.76], p=0.014) and adjusted (aOR 0.16 [95%CI, 0.05–0.55], p=0.004) analyses. After stratifying by pathologies, only IS autoimmune diseases remained significant (aOR 0.12 [95%CI, 0.03–0.57], p=0.007). Non-significant trends toward a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected in IS. CONCLUSIONS: In our cohort of COVID-19 patients, non-severe immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized host hyper-inflammatory response and warrants reconsideration of management of IS patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19.

Monreal

Maza

Gullón

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Most of these patients had symptoms that were comparable to those of the general population affected by COVID-19. Several interventions were followed in these SOT recipients with COVID-19, including reduction and withdrawal of immunosuppression, high-dose glucocorticoids, and treatment with experimental antiviral agents including chloroquine, lopinavir/ ritonavir, remdesivir, and umifenovir [12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 in solid organ transplant recipients: a single‐center experience

et al. 2020

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Summary Solid organ transplant (SOT) recipients may be at risk for severe COVID‐19. Data on the clinical course of COVID‐19 in immunosuppressed patients are limited, and the effective treatment strategy for these patients is unknown. We describe our institutional experience with COVID‐19 in SOT. Demographic, clinical, and treatment data were extracted from the electronic patient files. A total of 23 SOT transplant recipients suffering from COVID‐19 were identified (n = 3 heart; n = 15 kidney; n = 1 kidney‐after‐heart; n = 3 lung, and n = 1 liver transplant recipient). The presenting symptoms were similar to nonimmunocompromised patients. Eighty‐three percent (19/23) of the patients required hospitalization, but only two of these were transferred to the intensive care unit. Five patients died from COVID‐19; all had high Clinical Frailty Scores. In four of these patients, mechanical ventilation was deemed futile. In 57% of patients, the immunosuppressive therapy was not changed and only three patients were treated with chloroquine. Most patients recovered without experimental antiviral therapy. Modification of the immunosuppressive regimen alone could be a therapeutic option for SOT recipients suffering from moderate to severe COVID‐19. Pre‐existent frailty is associated with death from COVID‐19.

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“…Despite the presence of co-morbidity such as obesity and hypertension in our case, which is normally associated with worse outcome in COVID-19 disease, one could speculate whether her current immunosuppressive treatment actually protected her from the severe outcome. In line with those considerations, it is currently being vividly discussed whether immunosuppression may induce protection from the viral induced hyperin ammatory syndrome characterized by cytokine storms and multi-organ failure or whether chronic immunosuppression constitutes a risk factor for severe disease (3,9). It has been suggested that all patients with severe COVID-19 should be screened for hyperin ammatory biomarkers to identify subgroups of patients for whom speci c immunosuppression could improve outcome (9).…”

Section: Resultsmentioning

confidence: 99%

Recovery of moderate COVID-19 disease in a liver transplant recipient on continued immunosuppression

Mathiasen

Karlsen

Ott

et al. 2020

Preprint

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BackgroundThe global outbreak of severe acute respiratory syndrome coronavirus 2 has had an enormous impact on the world. It remains unclear to what extent liver transplant recipients should be considered at a higher risk of severe disease due to the limited data available.Case presentationWe describe a moderate course of COVID-19 in a patient who underwent a liver transplant two years earlier due to Budd-Chiari syndrome. She presented with malaise, headache, dry cough and fever for four days. Immunosuppressive therapy with tacrolimus and mycophenolate mofetil was continued throughout the course of infection, oxygen therapy was given for a single night and the patient gradually recovered with supportive care only.ConclusionsWith this case report, we demonstrate that liver transplantation and immunosuppression is not necessarily associated with severe COVID-19 disease and emphasize that more information on this matter is urgently required. Withdrawal of immunosuppressive therapy could be associated with a higher mortality.

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Covid-19 and Kidney Transplantation

Cited by 707 publications

References 4 publications

Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19.

Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19.

COVID‐19 in solid organ transplant recipients: a single‐center experience

Recovery of moderate COVID-19 disease in a liver transplant recipient on continued immunosuppression

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