Early Experience With COVID-19 and Solid Organ Transplantation at a US High-volume Transplant Center

Abstract

Background. The novel coronavirus severe acute respiratory syndrome coronavirus 2 [coronavirus disease 2019 (COVID-19)] poses unique challenges for immunosuppressed patients. Solid organ transplant (SOT) recipients comprise a large proportion of this group, yet there is limited knowledge about the presentation, clinical course, and immunosuppression management of this novel infection among heart, lung, liver, pancreas, and kidney transplant recipients. Methods. We present 21 SOT recipients diagnosed with COVID-19 between January 1, 2020 and April 22, 2020 at a US high-volume transplant center. Diagnostic workup, clinical course, immunosuppression/antiviral management, and immediate outcomes are described. Results. Twenty-one (15.9%) of 132 symptomatic patients tested were positive. Mean age at diagnosis was 54.8 ± 10.9 y. Median time from transplant was 5.58 y (interquartile range 2.25, 7.33). Median follow-up was 18 d (interquartile range 13, 30). Fourteen patients required inpatient management, with 7 (50%) placed in the intensive care unit (ICU). All transplant types were represented. Nearly 43% exhibited GI symptoms. Over half (56.2%) presented with elevated serum creatinine suggestive of acute kidney injury. The majority of patients (5/7) with concomitant infections at baseline required the ICU. Eighty percent received hydroxychloroquine ± azithromycin. Ten received toclizumab and/or ribavirin; 1 received remdesivir. Antimetabolites ± calcineurin inhibitors were held or reduced. Over half of hospitalized patients (8/14) were discharged home. Only 1 mortality (4.8%) to date, in a critically ill heart/kidney patient who had been in the ICU before diagnosis. Conclusions. COVID-19 positive SOT at our institution had favorable short-term outcomes. Those with concomitant infections had more severe illness. More data will be available to evaluate long-term outcomes and disease impact on graft function.

An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants

“…Published data are limited to case reports [6][7][8][9] and small single-center case series. [10][11][12][13][14][15][16][17][18][19][20][21] On March 1, 2020, a French nationwide registry of patients with COVID-19 and a history of solid organ transplantation was established under the auspices of the French-Speaking Society of Transplantation. As of April 21, 2020, a total of 598 patients were included in the registry-of whom 426 were KT recipients, 61 heart transplant recipients, 72 liver transplant recipients, and 39 lung transplant recipients.…”

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

“…Unlike other programmes, we have COVID-19 testing capabilities (compared to 47% of transplant centres in the United States) and are fortunate not to experience the high numbers and mortality of COVID-19 infected kidney transplant recipients in other countries (Table 4). [17][18][19][20][21][22][23][24][25][26] As with many crises, the COVID-19 pandemic has also brought out the courage, resilience and tenacity of our staff as well as demonstrated the remarkable abilities for different departments at SGH to quickly and effectively work together on urgent solutions. There is no doubt that we will emerge from the COVID-19 pandemic stronger and better than before.…”

General and Intensive Care Outcomes for Hospitalized Patients With Solid Organ Transplants With COVID-19

“…2,3 Since then, several series describe outcomes in solid-organ transplant recipients with COVID-19. 4,5 A larger study found solid-organ transplant recipients had worse outcomes with COVID-19 than non-transplanted patients, as has been shown for other infectious diseases. [6][7][8] In this study, we describe clinical characteristics and outcomes of a cohort of solid-organ transplant patients admitted to a large health system during the first month of the COVID-19 outbreak in New York.…”