Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A cohort study

Chaudhry, Zohra; Williams, Jonathan; Vahia, Amit; Fadel, Raef; Acosta, Tommy Parraga; Prashar, Rohini; Shrivastava, Pritika; Khoury, Nadeen J; Corrales, Julio Pinto; Williams, C.; Nagai, Shunji; Abouljoud, Marwan; Samaniego‐Picota, Milagros; Abreu-Lanfranco, Odaliz; Busto, Ramon Del; Ramesh, Mayur; Patel, Anita; Alangaden, George

doi:10.1111/ajt.16188

Cited by 125 publications

(172 citation statements)

References 31 publications

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“…Issues that potentially confound the Clarke et al analysis include the retrospective nature and relatively small sample size as well as limitations of accurate identification of true cases. Their data on mortality in kidney transplant recipients are however, similar to those reported by others and with respect to medical risk factors associated with mortality, and the higher proportion of patients from Black and other ethnic minorities ( 6 , 7 ). An important question not addressed in their analysis is how a diagnosis of COVID-19 in waitlisted patients who recover will affect their transplant candidacy and outcomes going forward.…”

supporting

confidence: 82%

New Answers to Old Questions: Waitlist Versus Transplant Outcomes in the Coronavirus Disease 2019 Era

Klassen¹

2021

Kidney International Reports

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supporting

confidence: 82%

New Answers to Old Questions: Waitlist Versus Transplant Outcomes in the Coronavirus Disease 2019 Era

Klassen¹

2021

Kidney International Reports

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“…Fever was common in studies, ranging from 52% to 95%; cough ranged from 49% to 78%, and dyspnoea from 28% to 70%. Gastrointestinal symptoms were also reported, as high as 53% in Chaudhry et al 26 Four studies reported data on AKI or graft dysfunction at presentation, ranging from 28% in Mohamed et al to 77% in Chen et al 20 , 27 No report described asymptomatic infection.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of COVID-19 and Kidney Transplantation

Mahalingasivam

Craik

Tomlinson

et al. 2021

Kidney International Reports

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Introduction Kidney transplant recipients are at increased susceptibility to many viral infections leading to justifiable anxiety about the effects of COVID-19. Methods We performed literature searches from multiple resources in April and August 2020 for relevant English and Chinese literature. Abstracts were screened, followed by full-text review with data extraction of reports that included at least 20 kidney transplant recipients with confirmed SARS-CoV-2 infection and completed outcomes. Results Twenty studies had sufficient data which we have summarised. Studies were predominantly descriptive and came from France, Italy, Spain, Turkey, UK, and USA. Quality assessment demonstrated limitations in selection of comparison groups and controlling for additional factors. Mortality rates from published studies were variable. Based on early data early from Spain, 46% of patients who developed COVID-19 within 60 days of transplantation died. Acute kidney injury was common, and mycophenolate was discontinued in most patients. Conclusion Given the rapid global spread of COVID-19, reliable evidence is needed to inform public health policies. Hospitalised kidney transplant recipients with COVID-19 are at a high risk of death in early reports but interpretation of this data requires caution as studies were susceptible to period effects. Reassuringly, the quality of observational data is improving. Detailed and comprehensive data collection through linked registries will be necessary to conduct accurate analyses of risk factors for adverse outcomes, not least given the risks of stopping immunosuppression. This report highlights the early mortality excess in transplant recipients but medium and longer-term outcomes remain uncertain and merit careful investigation.

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“… 25 - 27 Previously published data in SOT recipients reported fever as the most common presenting symptom. 8 - 11 Chaudhary et al 13 had 55% of SOT recipients with diarrhea on presentation, while 8.4% presented with altered mentation. In our study pulmonary symptoms were the most common presentation, while fever was observed only in 55% of our COVID-19-positive patients.…”

Section: Discussionmentioning

confidence: 99%

“… 7 - 11 Early published data show 16%–20% mortality among COVID-19-positive SOT recipients. 10 - 13 Long-term SOT recipients (transplanted >3 years), particularly those with kidney transplants, are primarily managed by their local healthcare providers with limited expertise in caring for this vulnerable cohort. With the increasing cases in our region and with tertiary centers being at capacity, community providers are increasingly having to care for COVID-19 positive patients.…”

mentioning

confidence: 99%

Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know

Basu

Patzer

Hosein

et al. 2020

Transplantation Direct

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Background. The current surge of coronavirus 2019 (COVID-19) cases in certain parts of the country has burdened the healthcare system, limiting access to tertiary centers for many. As a result, COVID-19-positive Solid Organ Transplant (SOT) recipients are increasingly being managed by local healthcare providers. It is crucial for community providers to understand disease severity and know if COVID-19-impacted SOT recipients have a different clinical course compared with COVID-19-negative SOT recipients with a similar presentation. Methods. We conducted a retrospective analysis on SOT recipients suspected to have COVID-19 infection tested during March 14, 2020–April 30, 2020. Patients were followed from time of testing to May 31, 2020. Results. One hundred sixty SOT recipients underwent testing: 22 COVID-19 positive and 138 COVID-19 negative. COVID-19-positive patients were more likely to have rapid progression of symptoms (median 3 vs 6 d, P = 0.002), greater hospitalizations (78% vs 64%, P < 0.017), and need for intensive care unit care (45% vs 17%, P < 0.001) Severe COVID-19 infection was not observed in patients on Belatacept for immunosuppression (30% vs 87%,P = 0.001). COVID- 19 positive patients in the intensive care unit were more likely to have multifocal opacities on radiological imaging in comparison to those admitted to the medical floor (90% vs 11%). Survival probability was similar in both cohorts. Conclusion. COVID-19-infected SOT recipients have a propensity for rapid clinical decompensation. Local providers need to be work closely with transplant centers to appropriately triage and manage COVID-19 SOT recipients in the community.

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Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A cohort study

Cited by 125 publications

References 31 publications

New Answers to Old Questions: Waitlist Versus Transplant Outcomes in the Coronavirus Disease 2019 Era

New Answers to Old Questions: Waitlist Versus Transplant Outcomes in the Coronavirus Disease 2019 Era

A Systematic Review of COVID-19 and Kidney Transplantation

Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know

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