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

Kim, Min Young; Brennan, Daniel C.; Shah, Pali D.

doi:10.1007/s40472-020-00305-y

Cited by 10 publications

(12 citation statements)

References 90 publications

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“…LTRs who were not at risk of immediate rejection often had antimetabolite immunosuppression held during the infectious period. 23 At our center, inpatient LTRs with COVID-19 were routinely screened with inflammatory markers, serum fungal biomarkers, sputum culture, and cytomegalovirus (CMV) viral load. When LTRs were treated with dexamethasone or tocilizumab, we started mold-active azoles for fungal prophylaxis, and empiric antibiotics for secondary pneumonia.…”

Section: Clinical Protocolsmentioning

confidence: 99%

Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study

et al. 2021

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Background. The impacts of COVID-19 on lung allograft function, rejection, secondary infection, and clinical outcomes in lung transplant recipients (LTRs) remain unknown. Methods. A 1:2 matched case–control study was performed to evaluate rehospitalization, lung allograft function, and secondary infections up to 90 d after COVID-19 diagnosis (or index dates for controls). Results. Twenty-four LTRs with COVID-19 (cases) and 48 controls were identified. Cases and controls had similar baseline characteristics and lung allograft function. LTRs with COVID-19 had higher incidence of secondary bacterial infection (29.2% versus 6.3%, P = 0.008), readmission (29.2% versus 10.4%, P = 0.04), and for-cause bronchoscopy (33.3% versus 12.5%, P = 0.04) compared with controls. At d 90, mortality in cases versus controls was 8.3% versus 2.1% (P = 0.21), incidence of invasive fungal infections in cases versus controls was 20.8% versus 8.3% (P = 0.13) and forced expiratory volume in 1 s (FEV1) decline ≥10% from baseline occurred in 19% of cases versus 12.2% of controls (P = 0.46). No acute cellular rejection, acute antibody-mediated rejection, or new donor-specific anti-HLA antibodies were observed among cases or controls within 90 d post index date. Conclusions. We found LTRs with COVID-19 were at risk to develop secondary infections and rehospitalization post COVID-19, compared with controls. While we did not observe post viral acute cellular rejection or antibody-mediated rejection, further studies are needed to understand if LTRs with COVID-19 who did not recover baseline lung function within 90 d have developed chronic lung allograft dysfunction stage progression.

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Section: Clinical Protocolsmentioning

confidence: 99%

Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study

et al. 2021

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“…Initial clues that the immune response to SARS-CoV-2 may differ among SOT recipients came from observational cohort studies that described clinical manifestations and virologic outcomes that were different from the non-transplant population [48]. For example, in the largest published series of transplant recipients with COVID-19, investigators reported lower rates of fever, higher rates of gastrointestinal symptoms, more significant lymphopenia, and higher case fatality rates compared to those described in the general population [3][4][5][6][7]49].…”

Section: Immune Responses To Sars-cov-2 In Sot Recipientsmentioning

confidence: 99%

Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients

et al. 2021

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Purpose of Review Coronavirus disease 2019 (COVID-19) is caused by a complex interplay between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics and host immune responses. Hosts with altered immunity, including solid organ transplant recipients, may be at increased risk of complications and death due to COVID-19. A synthesis of the available data on immune responses to SARS-CoV-2 infection is needed to inform therapeutic and preventative strategies in this special population. Recent Findings Few studies have directly compared immune responses to SARS-CoV-2 between transplant recipients and the general population. Like non-transplant patients, transplant recipients mount an exuberant inflammatory response following initial SARS-CoV2 infection, with IL-6 levels correlating with disease severity in some, but not all studies. Transplant recipients display anti-SARS-CoV-2 antibodies and activated B cells in a time frame and magnitude similar to non-transplant patientslimited data suggest these antibodies can be detected within 15 days of symptom onset and may be durable for several months. CD4 + and CD8 + T lymphopenia, a hallmark of COVID-19, is more profound in transplant recipients, but SARS-CoV-2-reactive T cells can be detected among patients with both mild and severe disease. Summary The limited available data indicate that immune responses to SARS-CoV-2 are similar between transplant recipients and the general population, but no studies have been sufficiently comprehensive to understand nuances between organ types or level of immunosuppression to meaningfully inform individualized therapeutic decisions. The ongoing pandemic provides an opportunity to generate higher-quality data to support rational treatment and vaccination strategies in this population.

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“…In a retrospective study, the majority of patients with severe COVID-19 showed significantly higher CRP levels as in the non-severe COVID-19 patients (57.9 mg/L vs. 33.2 mg/L, p < 0.001) [28]. Another retrospective study showed that CRP can effectively assess disease severity and predict outcomes in patients with COVID-19, with an increased risk of progression to a higher severity stage in patients with CRP levels >41.8 mg/L [29][30][31]. CRP values were found to be a more reliable indicator for earlier identification of case severity than CT scans alone [26].…”

Section: Crp As Marker Of Disease Activity In Covid-19mentioning

confidence: 98%

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

et al. 2021

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We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.

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

Cited by 10 publications

References 90 publications

Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study

Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study

Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

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