SARS‐CoV‐2 infection in kidney transplant recipients: Experience of the italian marche region

Maritati, Federica; Zuccatosta, Lina; Fiorentini, Alessandro; Finale, Carolina; Ficosecco, Marta; Cristiano, Fabrizio; Capestro, Alessandro; Balestra, Emilio; Taruscia, Domenica; Vivarelli, Marco; Donati, Abele; Perna, Gian Piero; Giacometti, Andrea; Tavio, Marcello; Onesta, Maicol; Sante, Laura Di

doi:10.1111/tid.13377

Cited by 22 publications

(29 citation statements)

References 32 publications

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“…Reports on immunocompromised adults with SARS-CoV-2 infection, including SOT recipients [ 6 ], including lung [ 7 ] and kidney [ 8–12 ], and patients receiving chemotherapy [ 13–16 ] indicate an increased rate of hospitalization and mortality. Adults taking biologics for immune-mediated inflammatory diseases, however, have not had worse COVID-19 outcomes [ 17 ].…”

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confidence: 99%

Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

Freeman

Rapsinski

Zilla

et al. 2020

Journal of the Pediatric Infectious Diseases Society

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Background The burden of COVID-19 is poorly understood in pediatric patients due to frequent asymptomatic and mild presentations. Additionally, the disease prevalence in pediatric immunocompromised patients remains unknown. Methods This cross-sectional study tested convenience samples from pediatric patients who had clinically indicated lab work collected and an immunocompromising condition, including oncologic diagnoses, solid organ transplant, bone marrow transplant, primary immunodeficiency, and rheumatologic conditions or inflammatory bowel disease on systemic immunosuppression, for the presence of antibodies to SARS-CoV-2. Results We tested sera from 485 children and observed SARS-CoV-2 seroprevalence of 1.0% (CI 95%: 0.3-2.4%). Two patients were positive by NP swab RT-PCR, but only one seroconverted. Patients with oncologic diagnoses or solid organ transplant were most likely to be tested for COVID-19 when presenting with respiratory illness as compared to other groups. Conclusions Seroprevalence of antibodies to SARS-CoV-2 in immunocompromised children was similar to that of an immunocompetent pediatric population (0.6%, CI 95%: 0.3-1.1%), suggesting an adequate antibody response. However, none of the patients who tested positive for antibodies or via NP RT-PCR had more than a mild illness course and two patients did not have any reported illness, suggesting that SARS-CoV-2 may not cause a worse clinical outcome in immunosuppressed children, in contrast to immunocompromised adults.

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confidence: 99%

Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

Freeman

Rapsinski

Zilla

et al. 2020

Journal of the Pediatric Infectious Diseases Society

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“…All 34 included studies were published in 2020, of which 15 studies reported prevalence outcomes[18-32] and 31 studies reported death outcomes[7, 18, 21-24, 26-50]. There were 17 cohort studies[7, 19, 20, 23-25, 27, 31, 33, 35, 40, 42, 44-46, 49, 50], 12 case series[21, 30, 34, 36-39, 41, 43, 47, 48], and five cross-sectional studies[22, 26, 28, 29, 32]. The number of samples per study ranged from 3 to 7,154 with a total of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions which nine countries were high-income countries and three were upper-middle-income countries according to the World Bank classification[51].…”

Section: Resultsmentioning

confidence: 99%

“…Female patients in each study were ranged from 0 to 57%. There were 20 studies on ESRD patients with kidney transplantation (KT) only[21, 23, 24, 26, 28, 30, 34-39, 41, 43, 45-50], ten studies with hemodialysis (HD) only[18-20, 22, 25, 27, 29, 32, 33, 40], four studies with more than one RRT modalities[7, 31, 42, 44], and no studies with peritoneal dialysis (PD) only (Table1).…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies focused on COVID-19 prevalence in ESRD patients with HD only with a pooled COVID-19 prevalence of 4.26% (95%CI 1.68–7.91)[18-20, 22, 25, 27, 29, 32]. Six studies had data on prevalence of COVID-19 in KT patients only with a pooled prevalence of 0.76% (95%CI 0.33–1.35)[21, 23, 24, 26, 28, 30]. Only one study had mixed data of COVID-19 prevalence in ESRD patients with HD or PD with a prevalence of 19.61% (95%CI 17.65–21.69) (Fig5)[31].…”

Section: Resultsmentioning

confidence: 99%

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Covid-19 in end-stage renal disease patients with renal replacement therapies: a systematic review and meta-analysis

Nopsopon

Kittrakulrat

Takkavatakarn

et al. 2021

Preprint

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IntroductionThe novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was no systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients who are on RRT.MethodsWe searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points.ResultsOf 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95%CI 14.09– 22.32) which was higher than the global average at 4.98%.ConclusionsThis meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.Author summaryChronic kidney disease (CKD) was associated with increasing severity and mortality of COVID-19. End-stage renal disease (ESRD) patients were at the terminal stage of CKD and had reduced immune function due to uremia. Additionally, ESRD patients with kidney transplantation had a diminished immune system from immunosuppressive agents. Kidneys might be the secondary target of SARS-CoV-2 after the respiratory tract regardless of the previous history of kidney disease, preferably the glomerulus, which was associated with the richness of some specific protein-coding genes in the kidney. The overall pooled prevalence in ESRD patients with renal replacement therapy was approximately 22 times of the referencing global average prevalence. The overall estimated case fatality rate of COVID-19 in ESRD patients with renal replacement therapy was approximately 3.6 times the global average. ESRD patients with renal replacement therapy had high COVID-19 prevalence and case fatality rate. We suggested that ESRD patients with renal replacement therapy should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.

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“…A total of 21 reports were screened, 5‐25 and 41 KTRs with laboratory‐confirmed COVID‐19 were enrolled.…”

Section: Resultsmentioning

confidence: 99%

Management of immunosuppression in kidney transplant recipients with COVID‐19 pneumonia: A summary of 41 confirmed cases reported worldwide

Zhong

Xiong

et al. 2020

Transplant Infectious Dis

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There is no consensus on immunosuppression management for kidney transplant recipients (KTRs) with SARS‐CoV‐2 pneumonia. Therefore, we conducted a search in English database from October 2019 to July 2020 and extracted data from cases with treatment details worldwide, and total of 41 recipients with a median age of 50 years were enrolled in this study. Most of them were males (75.8%). The most common presenting symptoms were fever (80.5%), cough (63.4%) and fatigue (41.5%). Patients were classified into three catalogs according to severity of pneumonia, 17 (41.5%) were mild, 15 (36.6%) severe and 9 (21.9%) critical disease. Laboratory tests revealed that serum creatinine of critical patients was significantly higher than that of mild or severe patients. 68.3% received oxygen support; all patients received antiviral therapy, 15 (36.6%) recipients were additionally treated with intravenous immunoglobulin and interferon‐α. 19.5% patients maintained immunosuppressive therapy; 36.6% suspended antimetabolite; 43.9% only treated with corticosteroid. 6 (14.6%) patients died (severe: 2, critical: 4); high creatinine with low lymphocyte count was the biggest challenge of immunosuppression management. In all, it is necessary to pay close attention to renal function and lymphocyte count in KTRs infected with COVID‐19, and choose appropriate medication programs according to the specific situations.

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SARS‐CoV‐2 infection in kidney transplant recipients: Experience of the italian marche region

Cited by 22 publications

References 32 publications

Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

Covid-19 in end-stage renal disease patients with renal replacement therapies: a systematic review and meta-analysis

Management of immunosuppression in kidney transplant recipients with COVID‐19 pneumonia: A summary of 41 confirmed cases reported worldwide

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