Coronavirus Disease 2019 Management Strategies in Solid Organ Transplant Recipients

Mendoza, Maria A.; Razonable, Raymund R.

doi:10.1016/j.idc.2023.03.003

Cited by 3 publications

(3 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, there are no randomized clinical trials (RCT) of COVID-19 treatments that focus on the SOT population. Therefore, the data supporting their use in this specific high-risk population are extrapolated from clinical trials in general non-transplant patients and from real-world experiences described in a multitude of retrospective studies in SOT recipients that have been published to date ( 22 ). Aggressive treatment of patients with SOT is highly recommended because immunosuppressed patients have a well-described blunted antibody response to infection and remain at a high risk of severe outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of SARS-CoV-2 infection in lung transplant recipients

Zhang,

Li,

et al. 2024

Front. Surg.

View full text Add to dashboard Cite

ObjectiveThis study aimed to investigate the clinical manifestations and prognosis of lung transplant (LTx) recipients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus disease (COVID-19) pandemic.MethodsThe research participants were LTx recipients who underwent surgery and were regularly followed up at our center. From 1 December 2022 to 28 February 2023, during the COVID-19 pandemic in China, research participants were interviewed either online or in person. SARS-CoV-2 nucleic acid or self-tested antigens were detected according to accessibility. Diagnosis and treatment were performed according to the Diagnosis and Treatment Plan for COVID-19 (10th edition) issued by the National Health Commission of the People's Republic of China. Hospitalized patients underwent chest imaging examinations, routine blood tests, biomarkers for infection and inflammation, and biochemical tests, all of which were taken and recorded. Data were analyzed to describe the features of COVID-19 in LTx recipients.ResultsIn total, 52 patients were enrolled in this study, comprising 48 men and 4 women, with a mean age of 51.71 ± 11.67 years. By 1 December 2022, the mean survival period was 33.87 ± 25.97 months, of which 84.61% of the patients (44/52) had a survival period longer than 12 months. The SARS-CoV-2 infection rate in these LTx recipients was 82.69% (43/52), with 3.85% (2/52) of the infected recipients being asymptomatic, 50.00% (26/52) of the infected recipients experiencing mild COVID-19, 11.54% (6/52) having moderate COVID-19, and 17.31% (9/52) having severe or critical COVID-19. The mortality rate among severe and critical patients was 66.67% (6/9).ConclusionLTx recipients in this cohort exhibited a notable susceptibility to SARS-CoV-2, with 82.69% of individuals diagnosed with COVID-19. Moreover, the mortality rate among critically ill patients was high.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of SARS-CoV-2 infection in lung transplant recipients

Zhang,

Li,

et al. 2024

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…Current guidelines for the treatment of solid organ transplant recipients with severe and critical COVID-19 recommend intravenous remdesivir with or without immunomodulation agents including dexamethasone, tocilizumab, or baricitinib[ 10 ]. Our findings in this study did not show a mortality benefit associated with remdesivir for management of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

Zona,

Gibes,

Jain

et al. 2024

World J Virol

View full text Add to dashboard Cite

BACKGROUND Kidney transplant recipients (KTR) are at risk of severe coronavirus disease 2019 (COVID-19) disease and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We predicted that hospitalization for COVID-19 and subsequent admission to the intensive care unit (ICU) would yield worse outcomes in KTRs. AIM To investigate outcomes among KTRs hospitalized at our high-volume transplant center either on the general hospital floor or the ICU. METHODS We retrospectively describe all adult KTRs who were hospitalized at our center with their first SARS-CoV-2 infection between 04/2020 and 04/2022 and had at least 12 months follow-up (unless they experienced graft failure or death). The cohort was stratified by ICU admission. Outcomes of interest included risk factors for ICU admission and mortality, length of stay (LOS), respiratory symptoms at admission, all-cause graft failure at the last follow-up, and death related to COVID-19. RESULTS 96 KTRs were hospitalized for SARS-COV-2 infection. 21 (22%) required ICU admission. The ICU group had longer hospital LOS (21.8 vs 8.6 days, P < 0.001) and were more likely to experience graft failure (81% vs 31%, P < 0.001). Of those admitted to the ICU, 76% had death at last-follow up, and 71% had death related to COVID-19. Risk factors for ICU admission included male sex (aHR: 3.11, 95%CI: 1.04-9.34; P = 0.04). Risk factors for all-cause mortality and COVID-19-related mortality included ICU admission and advanced age at SARS-CoV-2 diagnosis. Mortality was highest within a month of COVID-19 diagnosis, with the ICU group having increased risk of all-cause (aHR: 11.2, 95%CI: 5.11-24.5; P < 0.001) and COVID-19-related mortality (aHR: 27.2, 95%CI: 8.69-84.9; P < 0.001). CONCLUSION ICU admission conferred an increased risk of mortality, graft failure, and longer LOS. One-fifth of those hospitalized died of COVID-19, reflecting the impact of COVID-19-related morbidity and mortality among KTRs.

show abstract

“…Molnupiravir was more widely used and appeared to be beneficial. Remdesivir is an alternative treatment for high‐risk outpatients, with some data in support of remdesivir in SOT recipients 31 . We could not identify such patients for technical reasons, but assuming it is as effective as the oral antivirals, no more than 16 patients in the SOT cohort are likely to have been treated with remdesivir to prevent severe disease.…”

Section: Discussionmentioning

confidence: 99%

Risk of severe coronavirus disease 2019 despite vaccination in patients requiring treatment with immune‐suppressive drugs: A nationwide cohort study of US Veterans

Anand,

Vo,

et al. 2023

Transplant Infectious Dis

View full text Add to dashboard Cite

BackgroundPatients taking immune‐suppressive drugs are at increased risk of severe coronavirus disease 2019 (COVID‐19), not fully ameliorated by vaccination. We assessed the contributions of clinical and demographic factors to the risk of severe disease despite vaccination in patients taking immune‐suppressive medications for solid organ transplantation (SOT), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis.MethodsVeterans Health Administration electronic health records were used to identify patients diagnosed with RA, IBD, psoriasis, or SOT who had been vaccinated against severe acute respiratory syndrome coronavirus 2, were subsequently infected, and had received immune‐suppressive drugs within 3 months before infection. The association of severe (defined as hypoxemia, mechanical ventilation, dexamethasone use, or death) versus non‐severe COVID‐19 with the use of immune‐suppressive and antiviral drugs and clinical covariates was assessed by multivariable logistic regression.ResultsSevere COVID‐19 was more common in patients with SOT (230/1011, 22.7%) than RA (173/1355, 12.8%), IBD (51/742, 6.9%), or psoriasis (82/1125, 7.3%). Age was strongly associated with severe COVID‐19, adjusted odds ratio (aOR) of 1.04 (CI 1.03–1.05) per year. Comorbidities indicating chronic brain, heart, lung, or kidney damage were also associated with severity, aOR 1.35–2.38. The use of glucocorticoids was associated with increased risk (aOR 1.66, CI 1.39–2.18). Treatment with antivirals was associated with reduced severity, for example, aOR 0.28 (CI 0.13–0.62) for nirmatrelvir/ritonavir.ConclusionThe risk of severe COVID‐19 despite vaccination is substantial in patients taking immune‐suppressive drugs, more so in patients with SOT than in patients with inflammatory diseases. Age and severe comorbidities contribute to risk, as in the general population. Oral antivirals were very beneficial but not widely used. image

show abstract

Coronavirus Disease 2019 Management Strategies in Solid Organ Transplant Recipients

Cited by 3 publications

References 82 publications

Clinical characteristics and prognosis of SARS-CoV-2 infection in lung transplant recipients

Clinical characteristics and prognosis of SARS-CoV-2 infection in lung transplant recipients

Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

Risk of severe coronavirus disease 2019 despite vaccination in patients requiring treatment with immune‐suppressive drugs: A nationwide cohort study of US Veterans

Contact Info

Product

Resources

About