Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic

Gleeson, Shana; Formica, Richard N.; Marin, Ethan P.

doi:10.2215/cjn.04510420

Cited by 24 publications

(47 citation statements)

References 17 publications

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“… 58 Additionally, there is no proven benefit (and potential harm) of other agents such as intravenous immunoglobulin, interferon, HCQ, and azithromycin in KTRs except in anecdotal cases and their routine use is not recommended. 59 …”

Section: Managementmentioning

confidence: 99%

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

Kataria

Yakubu

Winstead

et al. 2020

Transplantation Direct

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The novel severe acute respiratory syndrome coronavirus 2 was identified in the late 2019 as the cause of coronavirus disease 2019 (COVID-19), an acute respiratory viral illness. Patients with chronic underlying conditions may have an increased risk of morbidity and mortality from COVID-19. Kidney transplant recipients may be at a uniquely increased risk of serious complications from COVID-19 as compared to the general population because of a chronically immunosuppressed state and a high prevalence of comorbidities like diabetes, heart disease, and lung disease. Early data suggest that the mortality of patients on dialysis may be comparable to those with kidney transplants, although more research is needed. This concise review aims to describe the epidemiology of COVID-19 in kidney transplant recipients, manifestations, appropriate management, and clinical outcomes based on the available literature. Current evidence on many of the specific antiviral measures against COVID-19 has not shown a clear-cut benefit in smaller studies and the results of several ongoing larger clinical trials are awaited. In addition, we also highlight the impact of COVID-19 on kidney transplant center practice and volumes; potential living or deceased donors, recipients; and induction immunosuppression and surgical strategies.

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Section: Managementmentioning

confidence: 99%

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

Kataria

Yakubu

Winstead

et al. 2020

Transplantation Direct

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“…Telemedicine may also be an important component of preparation for in-person encounters to reduce the amount of time spent in direct patient contact and to conduct necessary COVID-19 symptom and behavior risk screening (Fig. 1 ) [ 54 , 55 ]. For maximum utility, transplant centers may need to invest in resources for patient self-monitoring, including tools for vital signs monitoring, technology platforms, and resources to document objective findings.…”

Section: Outpatient Management For Transplant Recipientsmentioning

confidence: 99%

“…Ideally, when required, diagnostic tests should be performed at a facility that practices mitigation behaviors such as a restricted number of persons in waiting rooms, scheduled appointments, and strict screening of patients for COVID-19. Collaboration between transplantation specialists, monitoring of local COVID infection rates, and the local health care provider may be required [ 54 , 56 ]. The frequency of allograft surveillance biopsies should be determined to take into account the individual risks and benefits, especially during this epidemic period.…”

Section: Outpatient Management For Transplant Recipientsmentioning

confidence: 99%

“…In KT recipients, the negative predictive value of dd-cfDNA for any active rejection at a cutoff of 1.0% was 84%, and thus may be a good non-invasive marker of allograft surveillance [ 57 ]. While its role in other solid organ transplants is still being defined, peripheral gene expression tests may also be helpful for surveillance for cardiac allograft rejection to reduce need for invasive biopsies [ 54 ].…”

Section: Outpatient Management For Transplant Recipientsmentioning

confidence: 99%

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General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection

2020

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Purpose of Review Insufficient knowledge about COVID-19 and the potential risks of COVID-19 are limiting organ transplantation in wait-listed candidates and deferring essential health care in solid organ transplant recipients. In this review, we expand the understanding and present an overview of the optimized management of COVID-19 in solid organ transplant recipients. Recent Findings Transplant recipients are at an increased risk of severe COVID-19. The unique characteristics of transplant recipients can make it more difficult to identify COVID-19 . Based on the COVID-19 data to date and our experience, we present testing, management, and prevention methods for COVID-19. Comprehensive diagnostic tests should be performed to determine disease severity, phase of illness, and identify other comorbidities in transplant recipients diagnosed with COVID-19. Outpatients should receive education for preventative measures and optimal health care delivery minimizing potential infectious exposures. Multidisciplinary interventions should be provided to hospitalized transplant recipients for COVID-19 because of the complexity of caring for transplant recipients. Summary Transplant recipients should strictly adhere to infection prevention measures. Understanding of the transplant specific pathophysiology and development of effective treatment strategies for COVID-19 should be prioritized.

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“…Ali Husain et al [6] published their experiences in a symptomatic kidney transplant recipient with COVID-19 at an outpatient setting, and they found similar demographic and clinical characteristics compared with inpatient cases. According to a recent review by Gleeson et al, [7] criteria for outpatient follow-up were proposed to be lack of fever, no dyspnea, maintaining adequate oral intake, and the ability to maintain close communication with their transplant team. Advantages of this approach are avoiding unnecessary laboratory and imaging diagnostics, unnecessary burden in the health system, and exposure of uninfected individuals.…”

mentioning

confidence: 99%

Care of asymptomatic SARS‐CoV‐2 positive kidney transplant recipients

Velioğlu

2020

Transpl Int

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Sharing of experience amongst transplant community through various platforms and rapid publications has proven invaluable during the COVID‐19 pandemic (1‐3). The general consensus seemed to be that most kidney transplant recipients would have a moderate or mild course, although some may progress to a more severe disease. It was recommended to stop or decrease the dose of anti‐proliferative agents and continue with calcineurin inhibitors (CNIs) and maintenance steroids (4).

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Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic

Cited by 24 publications

References 17 publications

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection

Care of asymptomatic SARS‐CoV‐2 positive kidney transplant recipients

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