Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019

Husain, S. Ali; Dube, Geoffrey K.; Morris, Heather; Fernández, Hilda; Chang, Jae‐Hyung; Paget, Kathryn; Sritharan, Sharlinee; Patel, Shefali; Pawliczak, Olga; Boehler, Mia; Tsapepas, Demetra; Crew, R. John; Cohen, David; Mohan, Sumit

doi:10.2215/cjn.05170420

Cited by 94 publications

(101 citation statements)

References 8 publications

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“…Our findings suggest a clear difference in terms of outcome according to disease severity: patients with mild symptoms and manageable at home experienced a benign disease course, whereas patients requiring hospitalization experienced a mortality rate of 33%; the overall fatality rate of our population was 28%. Of interest, this wide spectrum of disease severity is in keeping with what is described in the general population as well as in other KTx transplant cohorts 10 although the mortality rate of the latter group, when presenting with severe disease, appears to be higher; 11 of note, this variability has been observed also in the hemodialysis population 12 …”

Section: Discussionsupporting

confidence: 80%

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience

Bossini

Alberici

Delbarba

et al. 2020

American Journal of Transplantation

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The outcome of kidney transplant patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is still unclear. Here we describe the clinical characteristics, disease outcome, and risk factors for acute respiratory distress syndrome (ARDS) and death of a cohort of 53 kidney transplant patients with coronavirus disease 2019 (COVID‐19). Eight of 53 have been handled as outpatients because of mild disease, on average with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin; no patients required admission, developed ARDS, or died. Because of severe symptoms, 45/53 required admission: this cohort has been managed with immunosuppression withdrawal, methylprednisolone 16 mg/d, hydroxychloroquine, and antiviral drugs. Dexamethasone and tocilizumab were considered in case of ARDS. About 33% of the patients developed acute kidney injury, 60% ARDS, and 33% died. In this group, thrombocytopenia was associated to ARDS whereas lymphopenia at the baseline, higher D‐dimer, and lack of C‐reactive protein reduction were associated with risk of death. In the overall population, dyspnea was associated with the risk of ARDS and age older than 60 years and dyspnea were associated with the risk of death with only a trend toward an increased risk of death for patients on tacrolimus. In conclusion, SARS‐CoV‐2 infection may have a variable outcome in renal transplant patients, with higher risk of ARDS and death in the ones requiring admission.

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Section: Discussionsupporting

confidence: 80%

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience

Bossini

Alberici

Delbarba

et al. 2020

American Journal of Transplantation

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“…In a newly published study from New York on the outpatient management of COVID-19, of 41 patients, 13 patients (32%) required hospitalization a median of 8 d (range, 1–16) after symptom onset, and 23 (56%) had outpatient symptom resolution a median of 12 d (4–23) after onset. 34 …”

Section: Manifestations and Clinical Outcomesmentioning

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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“…Diese Erfahrungen werden nun auf Infektionen mit SARS-CoV-2 übertragen; allerdings beschränkt sich die hierzu verfügbare Literatur bei Nierentransplantierten bislang auf kleine retrospektive Beobachtungsstudien meist hospitalisierter Patienten [16,17]. So bestand aufgrund der Immunsuppression und Erfahrungen mit Herpesviren die Sorge, dass nierentransplantierte Patienten ein deutlich erhöhtes Risiko für schwere COVID-19-Verläufe tragen [18].…”

Section: Nierentransplantierteunclassified

“…Andererseits zeigt sich (über die Gesamtheit der verfügbaren Studien gerechnet) ein letaler Ausgang in 19 der 162 beobachteten Fälle (11,7 %), sodass dennoch ein Risiko für schwere Verläufe zu bestehen scheint [16,17]. Detaillierte Metaanalysen dieser Studien sowie umfassende prospektive Untersuchungen stehen jedoch noch aus.…”

Section: Nierentransplantierteunclassified

COVID-19 aus Sicht des Nephrologen

Kann¹,

Benzing²

2020

Dtsch Med Wochenschr

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Increasing insight into the clinical phenotype and mechanisms of SARS-CoV-2 infections and COVID-19 has identified damage of the kidneys as a key player in the course of the disease. This manuscript summarizes the current knowledge on direct viral infection of kidney tissue, proteinuria and acute kidney injury in COVID-19, and management of patients on chronic dialysis as well as after kidney transplantation. Direct infection of podocytes and proximal tubular cells by SARS-CoV-2 has been confirmed and results in proteinuria and hematuria at an early stage of COVID-19. In this context, any kidney affection is a predictor of worse outcomes among COVID-19 patients irrespective of the initial presentation and increases the risk of acute kidney injury. Specific therapies for kidney damage and acute kidney injury within COVID-19 that could be generally recommended are currently lacking. Patients on chronic hemodialysis in particular are at risk for contracting SARS-CoV-2 infections as indicated by outbreaks and super-spreading events in hemodialysis facilities. Immunosuppressive therapy after kidney transplantation needs to be adapted upon diagnosis of COVID-19 depending on the severity of the initial presentation.

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Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019

Cited by 94 publications

References 8 publications

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience

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

COVID-19 aus Sicht des Nephrologen

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