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Bozkurt HB, Özdemir Ö. Changes regarding solid organ transplantation during the COVID-19 pandemic. World J Transplant 2025; 15:100591. [DOI: 10.5500/wjt.v15.i3.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 04/18/2025] Open
Abstract
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and emerged in Wuhan, China. It affects millions of people all over the world and has caused the deaths of thousands of people. Mortality rates were higher in transplant recipients and patients awaiting transplantation due to social and psychological issues. It also affected candidates who would be transplant providers and caused the transplant chain to be broken worldwide. The coronavirus disease 2019 pandemic has significantly affected solid organ transplantation procedures and led to various changes in protocols and practices to ensure patient safety and increase transplant success. These include challenges in screening protocols, prioritization of cases, telemedicine and virtual consultations, modified surgical procedures, immunosuppression management, updated research and guidelines, post-transplantation process and difficulties to control side effects, difficulties in organ procurement, and patient education/support. It requires a multidisciplinary approach, close collaboration between transplant teams, and adherence to strict infection control measures to ensure the safety of both transplant recipients and healthcare providers. In this article, we compiled the most important points in an overview of this process.
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Affiliation(s)
- Hayrunnisa Bekis Bozkurt
- Department of Pediatrics, Division of Allergy and Immunology, Ümraniye Research and Training Hospital, İstanbul 34400, Türkiye
| | - Öner Özdemir
- Department of Pediatrics, Division of Allergy and Immunology, Sakarya Research and Training Hospital, Sakarya University, Medical Faculty, Adapazarı 54100, Sakarya, Türkiye
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Lee JM, Sachithanandham J, Lee JS, Shapiro JR, Li M, Sitaris I, Peralta SR, Wouters C, Cox AL, Segev DL, Durand CM, Robien M, Tobian AAR, Karaba AH, Blankson JN, Werbel WA, Pekosz A, Klein SL. A third COVID-19 vaccine dose in kidney transplant recipients induces antibody response to vaccine and Omicron variants but shows limited Ig subclass switching. Microbiol Spectr 2025; 13:e0219024. [PMID: 39887251 PMCID: PMC11878001 DOI: 10.1128/spectrum.02190-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 12/12/2024] [Indexed: 02/01/2025] Open
Abstract
Solid organ transplant recipients (SOTRs) suffer more frequent and more severe infections due to their compromised immune responses resulting from immunosuppressive treatments designed to prevent organ rejection. Pharmacological immunosuppression can adversely affect immune responses to vaccination. A cohort of kidney transplant recipients (KTRs) received their third dose of ancestral, monovalent COVID-19 vaccine in the context of a clinical trial and antibody responses to the vaccine strain, as well as two Omicron variants BA.1 and BA.5 were investigated and compared with healthy controls who also received a third dose of mRNA vaccine (HCs). Total IgG and live virus neutralizing antibody titers were reduced in KTRs compared with controls for all variants. KTRs displayed altered IgG subclass switching, with significantly lower IgG3 antibodies. Responses in KTRs were also very heterogeneous, with some individuals showing strong responses but a significant number showing no Omicron-specific neutralizing antibodies. Taken together, immune responses after COVID-19 vaccination in KTRs were not only lower than HCs but highly variable, indicating that simply increasing the number of vaccine doses alone may not be sufficient to provide greater protection in this population. These findings underscore the need for tailored vaccination strategies for immunosuppressed populations, such as KTRs. Alternative formulations and doses of COVID-19 vaccines should be considered for people with severely compromised immune systems, as more frequent vaccinations may not significantly improve the response, especially regarding neutralizing antibodies.IMPORTANCEThis study addresses the challenges faced by kidney transplant recipients (KTRs) in mounting effective immune responses against COVID-19. By evaluating the antibody responses to a third dose of monovalent mRNA COVID-19 vaccine and its effectiveness against Omicron subvariants (BA.1 and BA.5), this study reveals significant reductions in both binding and neutralizing antibodies in KTRs compared with healthy controls. The research highlights altered IgG subclass switching and heterogeneous responses within the KTR population. Reduced recognition of variants, coupled with differences in IgG subclasses, decreases both the quality and quantity of protective antibodies after vaccination in KTRs. These findings underscore the need for tailored vaccination strategies for immunosuppressed populations, such as KTRs. Alternative formulations and doses of COVID-19 vaccines should be considered for people with severely compromised immune systems, as more frequent vaccinations may not significantly improve the response, especially regarding neutralizing antibodies.
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Affiliation(s)
- Jenny M. Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S. Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janna R. Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ioannis Sitaris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephanie R. Peralta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Camille Wouters
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L. Cox
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark Robien
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew H. Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lee JM, Sachithanandham J, Lee JS, Shapiro JR, Li M, Sitaris I, Peralta SR, Wouters C, Cox AL, Segev DL, Durand CM, Robien M, Tobian AAR, Karaba AH, Blankson JN, Werbel WA, Pekosz A, Klein SL. A Third COVID-19 Vaccine Dose in Kidney Transplant Recipients Induces Antibody Response to Vaccine and Omicron Variants but Shows Limited Ig Subclass Switching. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.01.610689. [PMID: 39282433 PMCID: PMC11398397 DOI: 10.1101/2024.09.01.610689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Solid organ transplant recipients (SOTRs) suffer more frequent and more severe infections due to their compromised immune responses resulting from immunosuppressive treatments designed to prevent organ rejection. Pharmacological immunosuppression can adversely affect immune responses to vaccination. A cohort of kidney transplant recipients (KTRs) received their third dose of ancestral, monovalent COVID-19 vaccine in the context of a clinical trial and antibody responses to the vaccine strain, as well as to Omicron variants BA.1 and BA.5 were investigated and compared with healthy controls. Total IgG and live virus neutralizing antibody titers were reduced in KTRs compared to controls for all variants. KTRs displayed altered IgG subclass switching, with significantly lower IgG3 antibodies. Responses in KTRs were also very heterogeneous, with some individuals showing strong responses but a significant number showing no Omicron-specific neutralizing antibodies. Taken together, immune responses after COVID-19 vaccination in KTRs were not only lower than healthy controls but highly variable, indicating that simply increasing the number of vaccine doses alone may not be sufficient to provide greater protection in this population. Importance This study addresses the challenges faced by kidney transplant recipients (KTRs) in mounting effective immune responses against COVID-19. By evaluating the antibody responses to a third dose of monovalent mRNA COVID-19 vaccine and its effectiveness against Omicron subvariants (BA.1 and BA.5), this study reveals significant reductions in both binding and neutralizing antibodies in KTRs compared to healthy controls. The research highlights altered IgG subclass switching and heterogeneous responses within the KTR population. Reduced recognition of variants, coupled with differences in IgG subclasses, decreases both the quality and quantity of protective antibodies after vaccination in KTRs. These findings underscore the need for tailored vaccination strategies for immunosuppressed populations such as KTRs. Alternative formulations and doses of COVID-19 vaccines should be considered for people with severely compromised immune systems, as more frequent vaccinations may not significantly improve the response, especially regarding neutralizing antibodies.
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Affiliation(s)
- Jenny M Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ioannis Sitaris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephanie R Peralta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille Wouters
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea L Cox
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark Robien
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joel N Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Özdemir BH, Ok Atılgan A, Akyüz Özdemir A, Haberal M. Unmasking the Silent Threat: COVID-19's Pervasive Impact on Renal Allografts. EXP CLIN TRANSPLANT 2024; 22:522-530. [PMID: 39223810 DOI: 10.6002/ect.2023.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Growing evidence has highlighted the substantial effects of COVID-19 on kidneys, ranging from mild proteinuria to severe acute kidney injury. However, comprehensive assessments of histopathological features in renal allograft biopsies are lacking. MATERIALS AND METHODS Seventeen kidney transplant recipients with COVID-19 between March 2020 and November 2022 were evaluated. Clinical characteristics, pathological findings, and outcomes were studied. RESULTS Six kidney transplant recipients (35.3%) developed acute kidney injury, leading to the requirement for hemodialysis. COVID-19 severity, as indicated by pneumonia (P = .028) and hospitalization (P = .002), was significantly associated with development of acute kidney injury. Most patients with COVID-19 (82.4%) showed considerably increased proteinuria levels (82.4%), along with presence of new-onset microscopic hematuria (35.3%) and nephrotic syndrome (58.8%). Tubular viral inclusionlike changes were detected in 47.1% of cases and were associated with a higher risk of graft loss (75%). Thrombotic microangiopathy and endothelial cell swelling in glomeruli were prevalent, highlighting extensive endothelial cell injury. Most recipients (88.2%) experienced rejection after COVID-19, with graft loss occurring in 46.7% of these cases. Biopsies revealed collapsing (n = 5), noncollapsing (n = 3), and recurrent (n = 2) focal segmental glomerulosclerosis, as well as acute tubulointerstitial nephritis (n = 3), crescentic glomerulonephritis with immunoglobulin A nephropathy (n = 1), and membranoproliferative glomerulonephritis (n = 1), in 129.7 ± 33 days. Eight patients experienced graft loss (8.2 ± 2 mo posttransplant). Hospitalization (P = .044) and viralinclusion-like nuclear changes in tubules (P = .044) significantly influenced graft survival. Collapsing (60%) and noncollapsing (66.7%) focal segmental glomerulosclerosis increased the risk of graft loss. CONCLUSIONS COVID-19 has had a multifaceted and enduring effect on renal allografts, urging the need for meticulous monitoring and tailored management strategies to mitigate the risk of severe kidney-related complications and graft loss in this vulnerable population.
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Affiliation(s)
- B Handan Özdemir
- >From the Pathology Department, Faculty of Medicine, Baskent University, Ankara, Türkiye
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Smith C, Novara ME, Cona A, Dolcimascolo A, Cancellieri G, Mortillaro F, Giannini EO, Carollo A, Mularoni A, Provenzani A. Efficacy and Safety of Remdesivir in Adult Solid Organ Transplant Recipients: A Scoping Review. Pharmaceuticals (Basel) 2024; 17:765. [PMID: 38931432 PMCID: PMC11206602 DOI: 10.3390/ph17060765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The SARS-CoV-2 infection has been associated with important mortality, particularly in immunocompromised patients, including solid organ transplant (SOT) recipients. Remdesivir (RDV) is an antiviral drug that has proven to be effective in reducing the replication of the virus in host cells, by which it may reduce the progression of symptoms and, consequently, the length of hospital stay and mortality. Randomized controlled trials have evaluated its use in the general population but never in SOT recipients. For the first time in this review, the safety and efficacy of RDV is evaluated in this specific population. The literature research was conducted using PubMed/MEDLINE and Scopus databases from 1 January 2020 to 24 November 2023, and 23 studies were analyzed. Although no clinical studies specifically evaluating this population have been conducted yet, RDV is likely safe for SOT patients when compared to the general population, so prescribers should consider utilizing RDV in SOT patients who are at high risk for progression to severe COVID-19. Future research will allow for the confirmation of the observed results and the acquisition of broader and clearer data regarding the safety and efficacy of the drug in this specific setting.
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Affiliation(s)
- Catherine Smith
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 5261, USA;
| | - Maria Eugenia Novara
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy; (A.C.); (A.P.)
| | - Andrea Cona
- Infectious Diseases Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy; (A.C.); (A.M.)
| | - Anna Dolcimascolo
- School of Specialization in Hospital Pharmacy, University of Palermo, 90133 Palermo, Italy; (A.D.); (G.C.); (F.M.); (E.O.G.)
| | - Giulia Cancellieri
- School of Specialization in Hospital Pharmacy, University of Palermo, 90133 Palermo, Italy; (A.D.); (G.C.); (F.M.); (E.O.G.)
| | - Francesca Mortillaro
- School of Specialization in Hospital Pharmacy, University of Palermo, 90133 Palermo, Italy; (A.D.); (G.C.); (F.M.); (E.O.G.)
| | - Enrico Ottavio Giannini
- School of Specialization in Hospital Pharmacy, University of Palermo, 90133 Palermo, Italy; (A.D.); (G.C.); (F.M.); (E.O.G.)
| | - Anna Carollo
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy; (A.C.); (A.P.)
| | - Alessandra Mularoni
- Infectious Diseases Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy; (A.C.); (A.M.)
| | - Alessio Provenzani
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy; (A.C.); (A.P.)
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Shinde AS, Kapoor D. Infections After Liver Transplant -Timeline, Management and Prevention. J Clin Exp Hepatol 2024; 14:101316. [PMID: 38264574 PMCID: PMC10801311 DOI: 10.1016/j.jceh.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Liver transplantation (LT) is the standard treatment for end- stage liver disease. Patient and graft survival have improved significantly in the last three decades owing to improvement in surgical technique, better perioperative management and better immunosuppressive regimens. However, LT recipients are at increased risk of infections, particularly in the first year after transplantation. The risk of infection is directly proportional to immunosuppressive regimen and graft function. In this review, we will briefly discuss the timeline of infections after liver transplant, preventive strategies and management of infectious complications.
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Affiliation(s)
- Ajay S. Shinde
- Consultant Gastroenterologist and Hepatologist, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Dharmesh Kapoor
- Consultant Hepatologist, Yashoda Hospitals, Secunderabad, Telangana, India
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Zhang W, Li Q, Ma Z, Han Z, Hu S, Xia T, Zhu Z, Wei L. Clinical characteristics and prognosis of SARS-CoV-2 infection in lung transplant recipients. Front Surg 2024; 11:1354994. [PMID: 38752128 PMCID: PMC11094252 DOI: 10.3389/fsurg.2024.1354994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This 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. Methods The 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. Results In 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). Conclusion LTx 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.
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Affiliation(s)
- Wenping Zhang
- Department of Thoracic Surgery/Lung Transplantation, Zhengzhou Key Laboratory for Surgical Treatment for End-Stage Lung Disease, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
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Connor AA, Adelman MW, Mobley CM, Moaddab M, Erhardt AJ, Hsu DE, Brombosz EW, Sanghvi M, Cheah YL, Simon CJ, Hobeika MJ, Saharia AS, Victor DW, Kodali S, Basra T, Graviss EA, Nguyen DT, Elsaiey A, Moore LW, Nigo M, Drews AL, Grimes KA, Arias CA, Li XC, Gaber AO, Ghobrial RM. Single-center Outcomes After Liver Transplantation With SARS-CoV-2-Positive Donors: An Argument for Increased Utilization. Transplant Direct 2024; 10:e1590. [PMID: 38464428 PMCID: PMC10923316 DOI: 10.1097/txd.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
Background The COVID-19 pandemic has led to an increase in SARS-CoV-2-test positive potential organ donors. The benefits of life-saving liver transplantation (LT) must be balanced against the potential risk of donor-derived viral transmission. Although emerging evidence suggests that the use of COVID-19-positive donor organs may be safe, granular series thoroughly evaluating safety are still needed. Results of 29 consecutive LTs from COVID-19-positive donors at a single center are presented here. Methods A retrospective cohort study of LT recipients between April 2020 and December 2022 was conducted. Differences between recipients of COVID-19-positive (n = 29 total; 25 index, 4 redo) and COVID-19-negative (n = 472 total; 454 index, 18 redo) deceased donor liver grafts were compared. Results COVID-19-positive donors were significantly younger (P = 0.04) and had lower kidney donor profile indices (P = 0.04) than COVID-19-negative donors. Recipients of COVID-19-positive donor grafts were older (P = 0.04) but otherwise similar to recipients of negative donors. Donor SARS-CoV-2 infection status was not associated with a overall survival of recipients (hazard ratio, 1.11; 95% confidence interval, 0.24-5.04; P = 0.89). There were 3 deaths among recipients of liver grafts from COVID-19-positive donors. No death seemed virally mediated because there was no qualitative association with peri-LT antispike antibody titers, post-LT prophylaxis, or SARS-CoV-2 variants. Conclusions The utilization of liver grafts from COVID-19-positive donors was not associated with a decreased overall survival of recipients. There was no suggestion of viral transmission from donor to recipient. The results from this large single-center study suggest that COVID-19-positive donors may be used safely to expand the deceased donor pool.
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Affiliation(s)
- Ashton A. Connor
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Max W. Adelman
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, HMH, Houston TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Constance M. Mobley
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Mozhgon Moaddab
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - Alexandra J. Erhardt
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
| | - David E. Hsu
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
| | | | - Mansi Sanghvi
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Yee Lee Cheah
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Caroline J. Simon
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Mark J. Hobeika
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Ashish S. Saharia
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - David W. Victor
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
| | - Sudha Kodali
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
| | - Tamneet Basra
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
| | - Edward A. Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Ahmed Elsaiey
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Linda W. Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Masayuki Nigo
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ashley L. Drews
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kevin A. Grimes
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Cesar A. Arias
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Xian C. Li
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
- Immunobiology and Transplant Science Center, Houston Methodist Hospital, Houston, TX
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - R. Mark Ghobrial
- Department of Surgery, Houston Methodist Hospital, Houston, TX
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX
- Department of Surgery, Weill Cornell Medical College, New York, NY
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX
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9
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Ulrich S, Balmer C, Becker K, Bruhs J, Danne F, Debus V, Dewein L, Di-Bernardo S, Doll U, Fleck T, Tirilomis T, Glöckler M, Grafmann M, Greil S, Grosser U, Saur P, Skrzypek S, Steinmetz M. COVID-19 infection in patients with history of pediatric heart transplant in Germany, Austria, and Switzerland. Clin Transplant 2024; 38:e15272. [PMID: 38445550 DOI: 10.1111/ctr.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
COVID-19 is a heterogenous infection-asymptomatic to fatal. While the course of pediatric COVID-19 infections is usually mild or even asymptomatic, individuals after adult heart transplantation are at high risk of a severe infection. We conducted a retrospective, multicenter survey of 16 pediatric heart transplant centers in Germany, Austria and Switzerland to evaluate the risk of a severe COVID-19 infection after pediatric heart transplantation between 02/2020 and 06/2021. Twenty-six subjects (11 male) with a median age of 9.77 years at time of transplantation and a median of 4.65 years after transplantation suffered from COVID-19 infection. The median age at time of COVID-10 infection was 17.20 years. Fourteen subjects had an asymptomatic COVID-19 infection. The most frequent symptoms were myalgia/fatigue (n = 6), cough (n = 5), rhinitis (n = 5), and loss of taste (n = 5). Only one subject showed dyspnea. Eleven individuals needed therapy in an outpatient setting, four subjects were hospitalized. One person needed oxygen supply, none of the subjects needed non-invasive or invasive mechanical ventilation. No specific signs for graft dysfunction were found by non-invasive testing. In pediatric heart transplant subjects, COVID-19 infection was mostly asymptomatic or mild. There were no SARS-CoV-2 associated myocardial dysfunction in heart transplant individuals.
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Affiliation(s)
- Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Christian Balmer
- Department of Pediatric Cardiology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Kolja Becker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josefin Bruhs
- Center of Congenital Heart Disease/Pediatric Cardiology, HDZ-NRW, Ruhr-University, Bad Oeynhausen, Germany
| | - Friederike Danne
- Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Volker Debus
- Department of Pediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Leonie Dewein
- Department of Pediatrics, University Hospital Ulm, Ulm, Germany
| | - Stefano Di-Bernardo
- Department of Pediatric Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Ulrike Doll
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theodor Tirilomis
- Department of Pediatric Cardiac Surgery, Georg-August-University-Goettingen, Gottingen, Germany
| | - Martin Glöckler
- Center for Congenital Heart Disease, University Hospital for Cardiology, Bern, Switzerland
| | - Maria Grafmann
- Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Germany
| | - Sabine Greil
- Department of Pediatric Cardiology, University Hospital Wien, Wien, Austria
| | - Urte Grosser
- Department of Pediatric Cardiology, University Hospital Hannover, Hannover, Germany
| | - Patrick Saur
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Skrzypek
- Department of Pediatric Cardiology, University Hospital Giessen, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine University Medical Center, Georg-August-University-Goettingen, Germany and German Center for Cardiovasvular Research (DZHK), Gottingen, Germany
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10
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Tamimi O, Tamimi F, Nisar T, Gaber AO, Lin J, Gorthi J, Gotur D. Clinical Outcomes of Heart Transplant Recipients Admitted with COVID-19 Infection in 2020: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101996. [PMID: 37506956 DOI: 10.1016/j.cpcardiol.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic, caused by infection of the SARS-CoV-2 virus, has impacted morbidity and mortality through widespread cytokine release and aberrant immunity; the mainstay of management has been immunosuppression. The aim of our retrospective study is to determine the effects of solid-organ transplantation (SOT) on COVID-19 admissions using data from the 2020 nationwide inpatient sample (NIS). After multivariate adjustment, we found COVID-19 admission with SOT had no difference in mortality (11.5% vs 11.1%, adjusted OR: 0.99 [95% CI 0.84-1.19, P = 0.99], no difference in need for vasopressor use (2.6% vs 1.8%, adjusted OR: 1.02 [95% CI 0.73-1.44, P = 0.88]), lower odds of requiring mechanical ventilation (MV) (13.7% vs 14.8%, adjusted OR: 0.83 [95% CI 0.71-0.97, P = 0.02]), lower odds of MV within 24 hours of admission (adjusted OR: 0.60 [95% CI 0.47-0.78, P < 0.01]), increased odds of mechanical circulatory support needs (adjusted OR 3.7 [95% CI 1.2-11.7, P = 0.025]), increased odds of acute renal failure requiring renal replacement therapy (adjusted OR 1.66 [95% CI 1.29-2.15, P < 0.01]), decreased mean length of stay (7.45 days vs 7.48 days, adjusted difference: 0.8 days less, P <0.01), and no difference in mean total hospitalization charges ($91,316 vs $79,100, adjusted difference: -$2,667, P = 0.57) compared to COVID-19 admissions without SOT.
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Affiliation(s)
- Omar Tamimi
- Department of Medicine, Houston Methodist Hospital, Houston, TX.
| | - Faisal Tamimi
- Department of Medicine, Jamaica Medical Center, Queens, NY
| | - Tariq Nisar
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston TX
| | - Ahmed Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Jiejian Lin
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Infectious Disease, Houston Methodist Hospital, Houston, TX
| | - Janardhana Gorthi
- Department of Medicine, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX; Division of Cardiology, Houston Methodist Hospital, Houston TX
| | - Deepa Gotur
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Critical Care, Houston Methodist Hospital, Houston, TX
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11
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Darılmaz Yüce G, Ulubay G, Tek K, Savaş Bozbaş Ş, Erol Ç, Büyükaşık P, Haberal KM, Arslan AH, Akçay MŞ, Haberal M. Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience. EXP CLIN TRANSPLANT 2023; 21:451-459. [PMID: 34635037 DOI: 10.6002/ect.2021.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. MATERIALS AND METHODS Our study included 23 solidorgan transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P <.05 was considered statistically significant. RESULTS Mean age of solid-organ transplant recipients was 49.8 ± 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P = .224). Transplant recipients had greater requirements for nasal oxygen (P = .005) and noninvasive mechanical ventilation (P = .003) and had longer length of intensive care unit stay (P = .030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P = .439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P <.05). Secondary infections were major causes of mortality in transplant recipients. CONCLUSIONS COVID-19 infection resulted in higher mortality in solid-organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.
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Affiliation(s)
- Gülbahar Darılmaz Yüce
- From the Department of Pulmonary Diseases Başkent University Faculty of Medicine, Ankara, Turkey
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12
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Castrezana-Lopez K, Malchow R, Nilsson J, Kokkonen SM, Rho E, von Moos S, Mueller TF, Schachtner T. Association between PIRCHE-II scores and de novo allosensitization after reduction of immunosuppression during SARS-CoV-2 infection in kidney transplant recipients. Transpl Infect Dis 2023; 25:e14052. [PMID: 36884207 DOI: 10.1111/tid.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Before the availability of mRNA vaccines, many transplant centers chose to significantly reduce maintenance immunosuppression in kidney transplant recipients (KTRs) with SARS-CoV-2 infection. The extent to which this increases the risk of allosensitization is unclear. METHODS In this observational cohort study, we analyzed 47 KTRs from March 2020 to February 2021 who underwent substantial reduction of maintenance immunosuppression during SARS-CoV-2 infection. KTRs were followed at 6 and 18 months concerning the development of de novo donor-specific anti-HLA (human leukocyte antigen) antibodies (DSA). The HLA-derived epitope mismatches were calculated using the predicted indirectly recognizable HLA-epitopes (PIRCHE-II) algorithm. RESULTS In total, 14 of 47 KTRs (30%) developed de novo HLA antibodies after the reduction of maintenance immunosuppression. KTRs with higher total PIRCHE-II scores and higher PIRCHE-II scores for the HLA-DR locus were more likely to develop de novo HLA antibodies (p = .023, p = .009). Furthermore, 4 of the 47 KTRs (9%) developed de novo DSA after reduction of maintenance immunosuppression, which were exclusively directed against HLA-class II antigens and also showed higher PIRCHE-II scores for HLA-class II. The cumulative mean fluorescence intensity of 40 KTRs with preexisting anti-HLA antibodies and 13 KTRs with preexisting DSA at the time of SARS-CoV-2 infection remained stable after the reduction of maintenance immunosuppression (p = .141; p = .529). CONCLUSIONS Our data show that the HLA-derived epitope mismatch load between donor and recipient influences the risk of de novo DSA development when immunosuppression is temporarily reduced. Our data further suggest that reduction in immunosuppression should be made more cautiously in KTRs with high PIRCHE-II scores for HLA-class II antigens.
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Affiliation(s)
| | - Ronja Malchow
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Sanna M Kokkonen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Elena Rho
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina von Moos
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Mueller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Schachtner
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
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13
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Swan JT, Rizk E, Jones SL, Nwana N, Nicolas JC, Tran AT, Xu J, Nisar T, Menser T, Yi SG, Moore LW, Huang HJ, Ghobrial RM, Gaber AO, Knight RJ. Hospitalization and survival of solid organ transplant recipients with coronavirus disease 2019: A propensity matched cohort study. PLoS One 2022; 17:e0278781. [PMID: 36534667 PMCID: PMC9762563 DOI: 10.1371/journal.pone.0278781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are predicted to have worse COVID-19 outcomes due to their compromised immunity. However, this association remains uncertain because published studies have had small sample sizes and variability in chronic comorbidity adjustment. METHODS In this retrospective cohort study conducted at a multihospital health system, we compared COVID-19 outcomes and survival up to 60 days following hospital admission in SOT recipients taking baseline immunosuppressants versus hospitalized control patients. RESULTS The study included 4,562 patients who were hospitalized with COVID-19 (108 SOT recipients and 4,454 controls) from 03/2020 to 08/2020. Mortality at 60 days was higher for SOT recipients (17% SOT vs 10% control; unadjusted odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.04-2.91, P = 0.04). We then conducted a 1:5 propensity matched cohort analysis (100 SOT recipients; 500 controls) using age, sex, race, body mass index, hypertension, diabetes, chronic kidney disease, liver disease, admission month, and area deprivation index. Within 28 days of admission, SOT recipients had fewer hospital-free days (median; 17 SOT vs 21 control; OR = 0.64, 95%CI 0.46-0.90, P = 0.01) but had similar ICU-free days (OR = 1.20, 95%CI 0.72-2.00, P = 0.49) and ventilator-free days (OR = 0.91, 95%CI 0.53-1.57, P = 0.75). There was no statistically significant difference in 28-day mortality (9% SOT vs 12% control; OR = 0.76, 95%CI 0.36-1.57, P = 0.46) or 60-day mortality (16% SOT vs 14% control; OR = 1.15, 95%CI 0.64-2.08, P = 0.64). CONCLUSIONS Hospitalized SOT recipients appear to need additional days of hospital care but can achieve short-term mortality outcomes from COVID-19 that are similar to non-SOT recipients in a propensity matched cohort study.
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Affiliation(s)
- Joshua T. Swan
- Department of Pharmacy, Houston Methodist, Houston, TX, United States of America
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
- * E-mail:
| | - Elsie Rizk
- Department of Pharmacy, Houston Methodist, Houston, TX, United States of America
| | - Stephen L. Jones
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Nwabunie Nwana
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Juan C. Nicolas
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Anh Thu Tran
- Department of Pharmacy, Houston Methodist, Houston, TX, United States of America
| | - Jiaqiong Xu
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Terri Menser
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States of America
| | - Stephanie G. Yi
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
| | - Linda W. Moore
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
| | - Howard J. Huang
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
- Department of Internal Medicine, Houston Methodist, Houston, TX, United States of America
| | - R. Mark Ghobrial
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
| | - Richard J. Knight
- Department of Surgery, Houston Methodist, Houston, TX, United States of America
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14
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Veeranki V, Prasad N, Meyyappan J, Bhadauria D, Behera MR, Kushwaha R, Patel MR, Yaccha M, Kaul A. The adverse effects of high-dose corticosteroid on infectious and non-infectious sequelae in renal transplant recipients with coronavirus disease-19 in India. Transpl Infect Dis 2022; 24:e13908. [PMID: 35870131 PMCID: PMC9349989 DOI: 10.1111/tid.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/05/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease-19 (COVID-19) is not well defined. We aimed to analyze the outcomes and infectious and non-infectious sequelae in RTR with COVID-19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID-19. MATERIALS AND METHODS This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID-19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non-infectious sequelae with reference to high-dose and standard-dose corticosteroids. RESULTS A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high-dose steroids was also significantly high in non-survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID-19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6-month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post-COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high-dose corticosteroid group than in the standard-dose group. CONCLUSION High-dose corticosteroid dosing in RTRs with COVID-19 was associated with increased infections, particularly fungal infections, and non-infectious sequelae with higher mortality on subsequent follow-up.
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Affiliation(s)
- Vamsidhar Veeranki
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Narayan Prasad
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Jeyakumar Meyyappan
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Dharmendra Bhadauria
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Manas R. Behera
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Ravi Kushwaha
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Manas R. Patel
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Monika Yaccha
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Anupama Kaul
- Department of Nephrology and Renal TransplantationSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
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15
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Outcomes of Anesthesiologist-Led Care of Patients Following Liver Transplantation During the COVID-19 Pandemic. Jt Comm J Qual Patient Saf 2022; 48:458-467. [PMID: 35792038 PMCID: PMC9186534 DOI: 10.1016/j.jcjq.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022]
Abstract
Background During the COVID-19 pandemic, anesthesiologists were redeployed as transplant ICU intensivists and a postanesthesia care unit was converted to a novel transplant ICU. This study compared the outcomes of patients undergoing liver transplantation under the new model with the prepandemic model. Methods Adult patients who underwent liver transplantation at an urban tertiary care center in the United States from December 28, 2015, through May 1, 2020, were identified and grouped according to date of procedure. Peri-COVID cases included transplants that were performed after March 3, 2020. Transplants performed before March 3, 2020, served as pre-COVID controls. Results A total of 523 liver transplant patients (30 study cases, 493 controls) were included. Kaplan-Meier survival analysis showed no significant difference in novel transplant ICU length of stay (N-TLOS) (median LOS 3.8 vs. 4.5 days, log-rank p = 0.60) and hospital length of stay (HLOS) (median LOS 14.2 vs. 14.5 days, log-rank p = 0.66). Cox proportional hazards regression with inverse probability of treatment weighting showed no difference in N-TLOS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.67–1.23, p = 0.55) or HLOS (HR 0.90, 95% CI 0.65–1.25, p = 0.52). In addition, there were no significant differences (pre-COVID vs. COVID) in time to extubation (median [interquartile range] 28.7 [20.6–50.7] vs. 26.8 [17.4–40.8] hours, p = 0.35), one-year patient survival (12.0% vs. 6.7%, p = 0.055), one-year graft survival (13.4% vs. 6.7%, p = 0.43), and readmission to the ICU (15.0% vs. 20.0%, p = 0.68). Conclusion Care provided by non-intensivist anesthesiologists to patients undergoing orthotopic liver transplantation during a pandemic emergency resulted in outcomes similar to those of care provided by intensivists.
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16
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Akbulut S, Sahin TT, Ince V, Yilmaz S. Impact of COVID-19 pandemic on clinicopathological features of transplant recipients with hepatocellular carcinoma: A case-control study. World J Clin Cases 2022; 10:4785-4798. [PMID: 35801031 PMCID: PMC9198872 DOI: 10.12998/wjcc.v10.i15.4785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on the management of all diseases. Various diseases such as cancer have a higher risk of COVID-19-related death. Despite this fact, any delay or alteration in treatment of cancer may have fatal consequences. Hepatocellular carcinoma (HCC) is an aggressive liver cancer that requires multimodality treatment to improve survival. AIM To evaluate the impact of COVID-19 on the management of patients with HCC by determining changes in demographic, clinical and histopathological variables. METHODS Demographic, clinical and pathological variables of patients with HCC who had undergone liver transplantation between March 2020 and June 2021 (Pandemic group, n = 48) were retrospectively compared with that of the patients with HCC transplanted between November 2018 and March 2020 (Pre-pandemic group, n = 61). RESULTS The median age of the patients in the study was 56 (interquartile range = 15). Ninety-seven patients (89%) were male and 12 were female (11%). The most common etiology of liver disease was hepatitis B virus (n = 52, 47.7%). According to our results, there was a 21.3% drop in the number of patients transplanted for HCC. There was no difference in the demographic, clinical and pathological characteristics of the patients except blood alkaline phosphatase levels (P = 0.029), lymphovascular invasion (P = 0.019) and type of the liver graft that was transplanted (P = 0.017). CONCLUSION It is important to develop a surveillance strategy for liver transplant centers. The liver transplantation for HCC is justified and safe provided that strict surveillance protocols are applied.
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Affiliation(s)
- Sami Akbulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Volkan Ince
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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17
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Impact of COVID-19 Infection on Children and Adolescents after Liver Transplantation in a Latin American Reference Center. Microorganisms 2022; 10:microorganisms10051030. [PMID: 35630472 PMCID: PMC9143523 DOI: 10.3390/microorganisms10051030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The COVID-19 infection has received the attention of the scientific community due to its respiratory manifestations and association with evolution to severe acute respiratory syndrome (SARS-CoV-2). There are few studies characterizing SARS-CoV-2 in pediatric immunocompromised patients, such as liver transplanted patients. The aim of this study was to analyze the outcomes of the largest cohort of pediatric liver transplant recipients (PLTR) from a single center in Brazil who were infected with COVID-19 during the pandemic. Methods: Cross-sectional study. Primary outcomes: COVID-19 severity. The Cox regression method was used to determine independent predictors associated with the outcomes. Patients were divided into two groups according to the severity of COVID-19 disease: moderate−severe COVID and asymptomatic−mild COVID. Results: Patients categorized as having moderate−severe COVID-19 were younger (12.6 months vs. 82.1 months, p = 0.03), had a higher prevalence of transplantation from a deceased donor (50% vs. 4.3%, p = 0.02), and had a higher prevalence of COVID infection within 6 months after liver transplantation (LT) (75% vs. 5.7%, p = 0.002). The independent predictor of COVID-19 severity identified in the multivariate analysis was COVID-19 infection <6 months after LT (HR = 0.001, 95% CI = 0.001−0.67, p = 0.03). Conclusion: The time interval of less than 6 months between COVID-19 infection and LT was the only predictor of disease severity in pediatric patients who underwent liver transplantation.
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18
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Altheaby A, Alloqmani D, AlShammari R, Alsuhaibani A, Hakeem A, Alam S, Alharbi S, Al Zunitan M, Bosaeed M, Alharbi NK. Safety and Efficacy of the COVID-19 Vaccine in Kidney Transplant Recipients. Cureus 2022; 14:e24753. [PMID: 35686249 PMCID: PMC9170370 DOI: 10.7759/cureus.24753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Kidney transplant recipients appear to be at high risk for critical coronavirus disease 2019 (COVID-19) illness. They are considered a priority for COVID-19 vaccination. Only a few studies report on the safety and efficacy of the COVID-19 vaccine in these patients. Methods: In this prospective observational study, we measured anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike-specific IgG post first and second COVID-19 mRNA vaccines in 113 kidney transplant recipients and compared them to 62 healthy volunteers. Result: After the first COVID-19 vaccine, SARS-CoV-2-specific antibodies were undetectable in 38.9% of kidney transplant recipients, and after the second, it remained undetectable in 12.4%. SARS-CoV-2-specific antibodies were significantly lower in kidney transplant recipients. The average antibody titer after the first vaccine was 1243.6±4137.5 in kidney transplant recipients compared to 20012.2±44436.4 in the controls after the first dose (P=0.002), and 7965.5±12431.3 versus 82891.3±67418.7, respectively, after the second dose (P <0.001). The immune response to the COVID-19 vaccine seemed to be influenced by mycophenolate dose in kidney transplant recipients and pre-vaccination infection. Conclusion: Kidney transplant recipients are prone to have attenuated antibody responses (anti-spike IgGs) to mRNA COVID-19 vaccines. Patients on mycophenolate mofetil (2 gm daily) had significantly lower SARS-CoV-2 spike-specific IgG levels as compared to patients on no or reduced dose of mycophenolate. Hence, kidney transplant recipients need to continue all infection control precautionary measures against COVID-19 infection and should be considered a priority for a third COVID-19 vaccine.
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19
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Clarysse M, Ceulemans LJ, Wauters L, Gilbo N, Capiau V, De Hertogh G, Laleman W, Verslype C, Monbaliu D, Pirenne J, Vanuytsel T. Potential importance of early treatment of SARS-CoV-2 infection in intestinal transplant patient: A case report. World J Transplant 2022; 12:72-78. [PMID: 35633850 PMCID: PMC9048441 DOI: 10.5500/wjt.v12.i4.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/13/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Predispositions for severe coronavirus disease 2019 (COVID-19) are age, immunosuppression, and co-morbidity. High levels of maintenance immunosuppression render intestinal transplant (ITx) patients vulnerable for severe COVID-19. COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx, so far. CASE SUMMARY During the second European COVID-19 wave in November 2020, an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration. Immunosuppression consisted of tacrolimus, azathioprine, and low-dose corticosteroids. During hospitalization, she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab, while her initial test was negative. She was initially asymptomatic and had normal inflammatory markers. Tacrolimus levels were slightly raised, as Azathioprine was temporarily halted. Due to elevated D-dimers at that time, prophylactic low-molecular weight heparin was started. Seven days after the positive test, dyspnea, anosmia, and C-reactive protein increase (25 mg/L) were noted. Remdesivir was administered during 5 d in total. High stomal output was noted in two consecutive days and several days thereafter. To exclude infection or rejection, an ileoscopy and biopsy were performed and excluded these. Four weeks later, she was discharged from the hospital and remains in good health since then. CONCLUSION Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.
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Affiliation(s)
- Mathias Clarysse
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Lucas Wauters
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Nicholas Gilbo
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Viktor Capiau
- Department of Pathology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Translational Cell & Tissue Research, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Clinical Digestive Oncology, Department of Digestive Oncology, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
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20
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Çaltık Yılmaz A, Baskın E, Gülleroğlu K, Karakaya D, Akdur A, Moray G, Haberal M. COVID-19 Infections in Pediatric Renal Transplant Recipients. EXP CLIN TRANSPLANT 2022; 20:156-160. [PMID: 35384829 DOI: 10.6002/ect.mesot2021.p82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The new coronavirus SARS-CoV-2 (COVID-19) first appeared in Turkey in March 2020, spread rapidly, and caused many deaths. Although COVID-19 is mostly a respiratory disease, it can cause kidney and multiorgan failure in some cases. We believe that by sharing information about the course and effects of COVID-19 infection in kidney transplant recipients receiving long-term immunosuppressive therapy our understanding will improve. MATERIALS AND METHODS Between March 2020 and October 2021, COVID-19 was researched in kidney transplant recipients under the age of 20 years who were followed at the Başkent University Transplantation Center. We documented the clinical characteristics and prognosis of pediatric kidney transplant recipients with COVID-19 disease. RESULTS Our study group included 23 patients with COVID-19 infection from 215 pediatric kidney transplant recipients. The mean age of the patients was 14.6 ± 4.7 years; there were 9 female patients. The mean follow-up time posttransplant was 62.3 ± 43.2 months. In 13 patients (56.5%), fever was the most frequent symptom. Most patients (n = 18, 78%) had minor symptoms and recovered completely after receiving supportive treatment. Four patients (17%) required hospitalization. One was diagnosed with COVID-19 infection 1 week after being treated with rituximab for acute antibody-mediated rejection. That patient died because of significant lung disease and multiorgan failure. CONCLUSIONS Despite the fact that most of our pediatric transplant recipients had mild symptoms of COVID-19, we believe that particular caution should be observed in patients who have recently received intensive immunosuppressive medications. As a result of potential new vaccines, national immunization programs, and the emergence of novel virus strains, the clinical picture may change in the future. We believe that, as information sharing increases, we will learn more about COVID-19 in renal transplant recipients.
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Affiliation(s)
- Aysun Çaltık Yılmaz
- From the Başkent University Department of Pediatric Nephrology, Ankara, Turkey
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21
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Wein AN, Liu J, Lin CY. Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS-CoV-2. Transpl Infect Dis 2022; 24:e13823. [PMID: 35279033 PMCID: PMC9115334 DOI: 10.1111/tid.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
Background Previous reports of coronavirus disease 2019 (COVID‐19) following lung transplantation generally described a grim prognosis, but these were anecdotal case series of symptomatic patients. A systematic study of the outcomes and pathology of SARS‐CoV‐2 infection in a large cohort of lung transplant patients is lacking. Methods To determine the histopathologic evolution of COVID‐19 in lung transplant recipients, we identified all patients who underwent surveillance transbronchial biopsies at our institution, tested positive for SARS‐CoV‐2, and had multiple pathology specimens available for evaluation. Histology was reviewed and immunofluorescence for SARS‐CoV‐2 nucleocapsid protein was performed. Results Ten patients met inclusion criteria. Half (5/10) had incidental diagnosis on routine respiratory pathogen testing at the time of transbronchial biopsy. Six patients were hospitalized, with three requiring intensive care unit (ICU) admission. One patient died. Two specimens showed new onset International Society for Heart and Lung Transplantation (ISHLT) Grade A2 rejection at or following diagnosis. One patient developed bronchiolitis obliterans 111 days following diagnosis and 1 year post transplant. Two patients had organizing pneumonia at diagnosis and three patients showed evolving lung injury following diagnosis. The SARS‐CoV‐2 nucleocapsid protein was detected in a subset of samples at diagnosis and up to 111 days following diagnosis. Conclusions Overall, the pathology of SARS‐CoV‐2 infection in lung transplant patients is varied, ranging from no pathologic alterations to organizing pneumonia and lung injury. The pathology findings did not necessarily correlate with clinical acuity, as one patient admitted to the ICU had normal pathology. These findings may be generalizable to non‐transplant patients and require more follow‐up regarding long‐term outcomes.
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Affiliation(s)
- Alexander N Wein
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Jing Liu
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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22
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Characteristics and Outcomes of Heart Transplant Recipients With Coronavirus-19 Disease in a High-volume Transplant Center. Transplantation 2022; 106:641-647. [PMID: 33756548 PMCID: PMC8862677 DOI: 10.1097/tp.0000000000003770] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplant (HT) recipients may be at higher risk of acquiring SARS-CoV-2 infection and developing critical illness. The aim of this study is to describe characteristics and outcomes of HT recipients infected by SARS-COV-2, from a high-volume transplant center. METHODS We have described data of all adult HT recipients with confirmed coronavirus disease 2019 by RT-PCR in nasopharyngeal samples from April 5, 2020, to January 5, 2021. Outcomes and follow-up were recorded until February 5, 2021. RESULTS Forty patients were included. Twenty-four patients (60%) were men; the median age was 53 (40-60) y old; median HT time was 34 mo; and median follow-up time 162 d. The majority needed hospitalization (83%). Immunosuppressive therapy was reduced/withdrawn in the majority of patients, except from steroids, which were maintained. Seventeen patients (42.5%) were classified as having severe disease according to the ordinal scale developed by the World Health Organization Committee. They tended to have lower absolute lymphocyte count (P < 0.001) during follow-up when compared with patients with mild disease. Thirty-day mortality was 12.5%. However, a longer follow-up revealed increased later mortality (27.5%), with median time to death around 35 d. Bacterial nosocomial infections were a leading cause of death. Cardiac allograft rejection (10%) and ventricular dysfunction (12.5%) were also not negligible. CONCLUSIONS Major findings of this study corroborate other cohorts' results, but it also reports significant rate of later events, suggesting that a strict midterm surveillance is advisable to HT recipients with coronavirus disease 2019.
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23
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Bansal N, Ovchinsky N, Foca M, Lamour JM, Kogan‐Liberman D, Hsu DT, Beddows K, Abraham L, Coburn M, Cunningham R, Nguyen T, Hayde N. COVID-19 infection in pediatric solid organ transplant patients. Pediatr Transplant 2022; 26:e14156. [PMID: 34633125 PMCID: PMC8646513 DOI: 10.1111/petr.14156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adult SOT recipients with COVID-19 have higher mortality rates when compared to general population. There is paucity of data on outcomes in pediatric SOT recipients. METHODS This is a cross-sectional study investigating the prevalence of COVID-19 infection and outcomes in pediatric SOT (heart, liver, and kidney) recipients. We extracted demographic and clinical characteristics and COVID-19 testing (PCR or [Ab] test) results from medical records. Clinical characteristics were compared between patients who were positive for COVID-19 (PCR or Ab) and those who did not, using Mann-Whitney, Student's t test, or chi-square test. p value <.05 was statistically significant. RESULTS A total of 108 SOT recipients with a median age of 13.1 (8.4, 17.8) years and median 4.2 (2.7, 7.9) years from transplant were checked for COVID-19 via a PCR or Ab test. A positive PCR was confirmed in 10 patients (9.3%), while 12 patients (11.1%) were positive for COVID-19 Ab. The patients who tested positive in our cohort were 9/50 (18%) heart, 6/68 (8.8%) kidney, and 7/50 (14%) liver transplant recipients. There were no differences in the clinical characteristics between patients with and without COVID-19 infection. All patients were either asymptomatic (50%) or had self-limiting symptoms. No changes were made to the immunosuppressive regimen. Only one patient was hospitalized and none had an oxygen requirement. CONCLUSIONS In our cohort of pediatric SOT recipients, COVID-19 infection was asymptomatic or mild. This data may aid clinicians in counseling patients and families in this increased-risk population.
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Affiliation(s)
- Neha Bansal
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Nadia Ovchinsky
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Marc Foca
- Division of Pediatric Infectious DiseasesChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Jacqueline M. Lamour
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Debora Kogan‐Liberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Daphne T. Hsu
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Kimberly Beddows
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Lincy Abraham
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Maura Coburn
- Division of Pediatric NephrologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Ryan Cunningham
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Trang Nguyen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Nicole Hayde
- Division of Pediatric NephrologyChildren’s Hospital at MontefioreBronxNew YorkUSA
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24
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Matejak-Górska M, Górska H, Zielonka M, Durlik M. The course of Covid-19 infection in patients after pancreas and kidney transplantation – a single - centre observation. Transplant Proc 2022; 54:917-924. [PMID: 35459465 PMCID: PMC8923976 DOI: 10.1016/j.transproceed.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Solid graft recipients are at an increased risk of serious complications and death. Out of 130 outpatient recipients of pancreas grafts at our Clinic, 20 patients (15.73%) had a confirmed severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2). Each patient had a different course of the disease, and the forms of infection varied from mild to severe and lethal. According to recommendations, after confirmation of the infection, mycophenolate mofetil was withdrawn and the immunosuppression was based on steroids and a calcineurin inhibitor. In this study, we performed an analysis of the course of COVID-19 infection in patients after pancreatic transplantation. Twenty pancreas recipients were confirmed to have COVID-19 infections; 4 of whom required hospitalization owing to severe complications. Patients reported weakness, excessive intensity of fatigue, shortness of breath with exertion, cough, and periodically increased temperature. Weakness and fatigue persisted in these patients for about 6 weeks. In 2 patients there was a need for oxygen supplementation and empirical antibiotic. Mortality was 5%, and there was 1 graftectomy. Deterioration of either kidney or pancreas graft were not observed in any other patients. The course of SARS-CoV-2 infection in solid graft recipients is similar to that of the rest of the population. Because of immunosuppression, recipients were accustomed to avoiding crowds and complying with obligations to wear masks.
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Affiliation(s)
- Marta Matejak-Górska
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland; Center of Postgraduate Medical Education, Department of General Surgery and Transplantology, Warsaw, Poland.
| | - Hanna Górska
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Michał Zielonka
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Marek Durlik
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland; Center of Postgraduate Medical Education, Department of General Surgery and Transplantology, Warsaw, Poland
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25
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One Year Into the Pandemic: Evolving COVID-19 Outcomes in Lung Transplant Recipients, a Single-center Experience. Transplant Direct 2022; 8:e1296. [PMID: 35368985 PMCID: PMC8966964 DOI: 10.1097/txd.0000000000001296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 12/20/2022] Open
Abstract
In the early months of the coronavirus disease 2019 (COVID-19) pandemic, our center reported a mortality rate of 34% in a cohort of 32 lung transplant recipients with COVID-19 between March and May 2020. Since then, there has been evolving knowledge in prevention and treatments of COVID-19. To evaluate the impact of these changes, we describe the clinical presentation, management, and outcomes of a more recent cohort of lung transplant recipients during the second surge and provide a comparison with our first cohort.
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26
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An W, Wang Q, Kim TE, Kang JS. Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: A systematic review and meta-analysis. J Infect Public Health 2022; 15:365-372. [PMID: 35193818 PMCID: PMC8857642 DOI: 10.1016/j.jiph.2022.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/03/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, South Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
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27
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Yanis A, Haddadin Z, Spieker AJ, Waqfi D, Rankin DA, Talj R, Thomas L, Birdwell KA, Ezzell L, Blair M, Eason J, Varjabedian R, Warren CM, Nochowicz CH, Olson EC, Simmons JD, Yoder S, Guy M, Thomsen I, Chappell JD, Kalams SA, Halasa NB. Humoral and cellular immune responses to the SARS-CoV-2 BNT162b2 vaccine among a cohort of solid organ transplant recipients and healthy controls. Transpl Infect Dis 2022; 24:e13772. [PMID: 34905653 DOI: 10.1111/tid.13772] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. METHODS We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses. RESULTS SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in SOT recipients, with some showing evidence of either humoral or cellular response, but not both. CONCLUSION Humoral and cellular immune responses to the BNT162b2 vaccine are markedly reduced in SOT recipients as compared to HCs, suggesting that SOT recipients may benefit from more tailored regimens such as higher dose and/or additional vaccinations.
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Affiliation(s)
- Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Danya Waqfi
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lora Thomas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly A Birdwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren Ezzell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcia Blair
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joan Eason
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekkah Varjabedian
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian M Warren
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia H Nochowicz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C Olson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua D Simmons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra Yoder
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madeline Guy
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isaac Thomsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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28
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Andargie TE, Zhou W, Karaba AH, Li T, Seifuddin F, Rittenhouse AG, Kong H, Singh K, Woodward R, Iacono A, Avery RK, Pirooznia M, Jang MK, Ji H, Cox AL, Agbor-Enoh S. Integrated cell-free DNA and cytokine analysis uncovers distinct tissue injury and immune response patterns in solid organ transplant recipients with COVID-19. RESEARCH SQUARE 2022:rs.3.rs-1262270. [PMID: 35075453 PMCID: PMC8786231 DOI: 10.21203/rs.3.rs-1262270/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
COVID-19 pathogenesis is associated with an exuberant inflammatory response. However, the tissue injury pattern and immune response in solid-organ transplant recipients (SOTRs) taking immunosuppressive therapy have not been well characterized. Here, we perform both cfDNA and cytokine profiling on plasma samples to map tissue damage, including allograft injury and delineate underlying immunopathology. We identified injuries from multiple-tissue types, including hematopoietic cells, vascular endothelium, hepatocyte, adipocyte, pancreas, kidney, heart, and lung in SOTRs with COVID-19 that correlates with disease severity. SOTRs with COVID-19 have higher plasma levels of cytokines such as IFN-λ1, IFN-γ, IL-15, IL-18 IL-1RA, IL-6, MCP-2, and TNF-α as compared to healthy controls, and the levels of GM-CSF, IL-15, IL-6, IL-8, and IL-10 were associated with disease severity in SOTRs. Strikingly, IFN-λ and IP-10 were markedly increased in SOTRs compared to immunocompetent patients with COVID-19. Correlation analyses showed a strong association between monocyte-derived cfDNA and inflammatory cytokines/chemokines in SOTRs with COVID-19. Moreover, compared to other respiratory viral infections, COVID-19 induced pronounced injury in hematopoietic, vascular endothelial and endocrine tissues. Allograft injury, measured as donor-derived cfDNA was elevated in SOTRs with COVID-19, including allografts distant from the primary site of infection. Allograft injury correlated with inflammatory cytokines and cfDNA from immune cells. Furthermore, longitudinal analysis identified a gradual decrease of cfDNA and inflammatory cytokine levels in patients with a favorable outcome. Our findings highlight distinct tissue injury and cytokine features in SOTRs with COVID-19 that correlate with disease severity.
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Affiliation(s)
- Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
- Department of Biology, Howard University, Washington DC
| | - Weiqiang Zhou
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Andrew H. Karaba
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Taibo Li
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Alex G. Rittenhouse
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Hyesik Kong
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
| | | | | | - Aldo Iacono
- Department of Medicine, University of Maryland, College Park, MD
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
| | - Hongkai Ji
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT) and Laboratory of Applied Precision Omics, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
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29
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Sait AS, Chiang TPY, Marr KA, Massie AB, Cochran W, Shah P, Brennan DC, Thomas AG, Mehta Steinke S, Permpalung N, Shoham S, Merlo C, Jain T, Boyarsky B, Charnaya O, Gurakar A, Sharma K, Durand CM, Werbel WA, Huang CY, Ostrander D, Desai N, Kim MY, Alasfar S, Bloch EM, Tobian AA, Garonzik-Wang J, Segev DL, Avery RK. Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics. Transplant Direct 2022; 8:e1268. [PMID: 34966840 PMCID: PMC8710330 DOI: 10.1097/txd.0000000000001268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections. METHODS We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March-May 2020, 21 patients; and Era 2: June-November 2020, 56 patients) and 52 solid organ transplant outpatients. RESULTS In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post-COVID-19 renal and liver function were comparable between eras, out to 90 d. CONCLUSIONS Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.
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Affiliation(s)
- Afrah S. Sait
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kieren A. Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Willa Cochran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pali Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Seema Mehta Steinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Merlo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tania Jain
- Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Brian Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olga Charnaya
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmet Gurakar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kavita Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chiung-Yu Huang
- Department of Statistics, University of California at San Francisco, San Francisco, CA
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Min Young Kim
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sami Alasfar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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30
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Sheikhalipour Z, Faghihdinevari M, Salehi-Pourmehr H, Khameneh M, Vahedi L. Covid-19 in kidney transplant recipients with immunosuppressive therapy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:161-172. [PMID: 35872680 PMCID: PMC9272967 DOI: 10.22088/cjim.12.4.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Since the outbreak of COVID-19, various treatments have been frequently reported for patients infected with this virus, especially in transplant patients/recipients. Objective: Investigating of kidney transplant patients under immunosuppressive therapy infected with COVID-19 can pave the way to understanding, handling, and treatment of COVID-19. METHODS We had a brief review of the literature on immunosuppressive therapy in kidney transplants infected with COVID-19. This was based on the PubMed Database with keywords "kidney, transplant, COVID-19, and immunosuppress" after hospitalization of kidney transplantation infected with COVID-19. He had already been recorded in the Organ Transplant Registry (ID≠ 64510) of Tabriz University of Medical Sciences /Iran. RESULTS We reported the clinical course of a 45-year-old man with a history of kidney transplantation and immunotherapy who was infected with COVID-19 with respiratory infections and positive RT-PCR (Real-time polymerase chain reaction). He was treated with hydroxychloroquine, Kaletra, CellCept, and prednisolone for 5 days, and finally discharged from the hospital. In addition, reviewing of 47 papers with 851 samples showed that immunosuppressant medications alone could be a therapeutic choice in kidney transplants infected with COVID-19 with careful management. CONCLUSION Patients with organ transplantation infected with COVID-19 may show different clinical signs, clinical course, and prognosis due to underlying diseases and the use of immunosuppressant medications. It might be best to continue taking the immunosuppressant medications but modify them based on the patients' conditions such as clinical symptoms, laboratory results, paraclinical examinations.
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Affiliation(s)
- Zahra Sheikhalipour
- Medical and Surgical Department, Nursing and Midwifery School, Organ Transplant Registry, Tabriz University of Medical Sciences, Iran
| | - Masood Faghihdinevari
- Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Khameneh
- Student Research Committee, Islamic Azad University of Tabriz, Tabriz, Iran
| | - Leila Vahedi
- Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran,Correspondence: Leila Vahedi, Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail: , Tel: 0098 4133351688, Fax: 0098 4133373741
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31
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Stainer A, Amati F, Suigo G, Simonetta E, Gramegna A, Voza A, Aliberti S. COVID-19 in Immunocompromised Patients: A Systematic Review. Semin Respir Crit Care Med 2021; 42:839-858. [PMID: 34918325 DOI: 10.1055/s-0041-1740110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first identified as a novel coronavirus in Wuhan, Hubei province, central China, in December 2019, and is responsible for the 2019-to-present pandemic. According to the most recent data released by the World Health Organization, more than 200 million people have been infected by SARS-CoV-2 so far, and more than 4 million people died worldwide. Although our knowledge on SARS-CoV-2 and COVID-19 is constantly growing, data on COVID-19 in immunocompromised patients are still limited. The aim of the present systematic review is to describe clinical picture, disease severity, proposed treatment regimen, and response to vaccination in patients with different types and severity of immunosuppression.
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Affiliation(s)
- Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Suigo
- Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edoardo Simonetta
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Respiratory Department, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Emergency Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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32
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Mornese Pinna S, Lupia T, Scabini S, Vita D, De Benedetto I, Gaviraghi A, Colasanto I, Varese A, Cattel F, De Rosa FG, Corcione S. Monoclonal antibodies for the treatment of COVID-19 patients: An umbrella to overcome the storm? Int Immunopharmacol 2021; 101:108200. [PMID: 34607231 PMCID: PMC8479899 DOI: 10.1016/j.intimp.2021.108200] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023]
Abstract
The world is facing up the most considerable vaccination effort in history to end the Coronavirus disease 2019 (COVID-19) pandemic. Several monoclonal antibodies (mAbs) direct against the Receptor binding domain of the S protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) received an Emergency Use Authorization for outpatient management of mild to moderate manifestation from COVID-19. MAbs could prevent the transmission SARS-CoV-2 infection and protect individuals from progression to severe disease. Under the pressure of different treatment strategies, SARS-CoV-2 has been demonstrated to select for different sets of mutations named "variants" that could impair the effectiveness of mAbs by modifying target epitopes. We provide an overview of both completed and unpublished, or ongoing clinical trials of mAbs used and review state of art in order to describe clinical options, possible indications, and the place in therapy for these agents in the treatment of COVID-19 with a particular focus on anti-spike agents. Then, we reassume the current evidence on mutations of the SARS-CoV-2 that might confer resistance to neutralization by multiple mAbs.
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Affiliation(s)
- Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, Italy.
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Davide Vita
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Irene Colasanto
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandra Varese
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Cattel
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy; Tufts University School of Medicine, Boston, MA, USA
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33
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Bhatti ABH, Nazish M, Khan NY, Manan F, Zia HH, Ilyas A, Ishtiaq W, Khan NA. Living Donor Liver Transplantation During the COVID-19 Pandemic: an Evolving Challenge. J Gastrointest Surg 2021; 25:3092-3098. [PMID: 34131867 PMCID: PMC8205313 DOI: 10.1007/s11605-021-05057-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center. METHODS Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19. RESULTS The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2). CONCLUSION Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation.
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Affiliation(s)
- Abu Bakar Hafeez Bhatti
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan.
- Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Malka Nazish
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Nusrat Yar Khan
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Fazal Manan
- Department of Hepatology, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Haseeb Haider Zia
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Abid Ilyas
- Department of Surgical Critical Care, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Wasib Ishtiaq
- Department of Surgical Critical Care, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | - Nasir Ayub Khan
- Department of Anesthesiology, Shifa International Hospital Islamabad, Islamabad, Pakistan
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34
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Early report from the Pediatric Heart Transplant Society on COVID-19 infections in pediatric heart transplant candidates and recipients. J Heart Lung Transplant 2021; 41:327-333. [PMID: 34903451 PMCID: PMC8604161 DOI: 10.1016/j.healun.2021.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background Reports focused on adult heart transplant (HTx) recipients with COVID-19 suggest an increased risk of severe disease, however; it is unclear if this holds true for pediatric HTx patients, given the typically milder course of illness in children in general with COVID-19. We sought to rapidly implement a system for multi-center data collection on pediatric HTx candidates and recipients, with the aim of describing the patient population and infection related outcomes. Methods The Pediatric Heart Transplant Society (PHTS) is a multi-center collaboration that seeks to improve the outcomes of children who are listed and undergo HTx. The society consists of pediatric HTx centers in North America (n = 53), UK (n = 2), and Brazil (n = 1). In response to the pandemic, PHTS developed a web-based platform to collect COVID-19 specific data on pediatric HTx candidates and recipients. Non-PHTS centers were also invited to submit data. Data fields included pre-and post-HTx patient characteristics, presumed versus documented infection, need for hospitalization (including ICU and ventilator use), treatments administered, and 30-day outcome (resolution, death, sequelae, and or unresolved) Results Data collection was initiated on 4/30/20. As of 03/15/21 there were 225 patients [19 pre-HTx and 206 post-HTx, median age 14 years (IQR 7, 18)] reported from 41 centers. Hospitalization occurred in 42% (n = 8) of the pre-HTx and 21% (n=43) of the post-HTx patients. Among the patients listed for HTx, 21% (n = 4) required ICU and 10.5% (n = 2) were mechanically ventilated. Among post-HTx patients, 7% (n = 14) required ICU and 1% (n = 3) were mechanically ventilated. At 30 days, the majority of patients had resolution of symptoms (94.7% pre-HTx, 95.6% post-HTx). One death was reported in a post-HTx patient prior to 30 days from onset of COVID-19 illness. Conclusions These data demonstrate the ability to rapidly adapt the PHTS data collection infrastructure in response to a novel infection and represent the first known multi-center report of characteristics and early outcomes for patients listed and following pediatric HTx with COVID-19. Hospitalization appears to be more common for both candidates and recipients due to COVID-19 than for the general pediatric population though stays were short and mortality minimal.
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35
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Muñoz Serrano A, Arias A, Moreno-Torres V, Calderón J, Vicente N, Cuervas-Mons V. Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control Study. Ann Transplant 2021; 26:e933152. [PMID: 34764235 PMCID: PMC8594113 DOI: 10.12659/aot.933152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background It is unclear whether solid organ transplant (SOT) patients have more severe coronavirus disease 2019 (COVID-19) and worse outcome than the general population. Material/Methods We conducted a case-control study on 32 SOT recipients and 84 non-SOT controls matched for age and sex admitted for confirmed COVID-19. The primary endpoint was in-hospital all-cause mortality rate. Secondary endpoints included severe acute respiratory distress syndrome (ARDS), use of high-flow oxygen therapy, and length of hospital stay. Results The median (IQR) Charlson comorbidity index (CCI) at admission was significantly higher in SOT recipients (6 (3–8) vs 3 (2–4); P<0.01). Fever was less frequent in SOT recipients (78% vs 94%, P=0.01). SOT recipients had a higher median SaO2/FiO2 at admission (452 [443–462] vs 443 [419–452], P<0.01) and reached the worst SaO2/FiO2 value later during hospitalization 15 (10–21) vs 11 (9–14) days, P=0.01). Both groups had a similar severe ARDS rate during hospitalization (33% vs 28%) (p=0.59). There were no significant differences during hospitalization in terms of highest level of respiratory support needed, or length of hospital stay: 8.5 (5.5–21) vs 11.5 (6.5–16.5) days; P=0.34) in SOT recipients when compared to controls. In-hospital all-cause mortality rates were significantly higher in SOT recipients (21.9% vs 4.7%, P<0.01; OR 1.08; 95% CI 0.10–10.98), but among patients who died, median CCI was similar between groups (8 [6–8] vs 7 [6–8]). Conclusions In our experience, hospitalized SOT recipients for COVID-19 had higher in-hospital mortality compared to non-SOT patients, probably due to the greater number of underlying comorbidities, and not directly related to chronic immunosuppression.
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Affiliation(s)
- Alejandro Muñoz Serrano
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Ana Arias
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahondada, Majadahonda, Spain
| | - Víctor Moreno-Torres
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Jorge Calderón
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Natalia Vicente
- Department of Internal Medicine, Hospital Universitario Sureste, Arganda del Rey, Spain
| | - Valentín Cuervas-Mons
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Weiss MJ, Hornby L, Foroutan F, Belga S, Bernier S, Bhat M, Buchan CA, Gagnon M, Hardman G, Ibrahim M, Luo C, Luong ML, Mainra R, Manara AR, Sapir-Pichhadze R, Shalhoub S, Shaver T, Singh JM, Srinathan S, Thomas I, Wilson LC, Wilson TM, Wright A, Mah A. Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic. Transplant Direct 2021; 7:e755. [PMID: 34514110 PMCID: PMC8425831 DOI: 10.1097/txd.0000000000001199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed. METHODS Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks. RESULTS The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation." CONCLUSIONS SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, Montréal, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
| | - Laura Hornby
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mamatha Bhat
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Gagnon
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Gillian Hardman
- National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Maria Ibrahim
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Kings College, London, United Kingdom
| | - Cindy Luo
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada
- St. Paul's Hospital, Saskatchewan Transplant Program, Saskatoon, SK, Canada
| | - Alex R Manara
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Ruth Sapir-Pichhadze
- Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Sarah Shalhoub
- Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada
| | - Tina Shaver
- Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Jeffrey M Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, ON, Canada
- Trillium Gift of Life Network, Toronto, ON, Canada
| | - Sujitha Srinathan
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ian Thomas
- National Health Service Blood and Transplant, Bristol, United Kingdom
- Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Lindsay C Wilson
- System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - T Murray Wilson
- Transplant Research Foundation of British Columbia, Vancouver, BC, Canada
- Patient Partner, Canadian Donation and Transplantation Research Program
- The Alberta ORGANization Group, Edmonton, AB, Canada
| | - Alissa Wright
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Mah
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Marinelli T, Ferreira VH, Ierullo M, Ku T, Lilly L, Kim SJ, Schiff J, Sidhu A, McDonald M, Hosseini-Moghaddam SM, Husain S, Rotstein C, Majchrzak-Kita B, Kulasingam V, Humar A, Kumar D. Prospective Clinical, Virologic, and Immunologic Assessment of COVID-19 in Transplant Recipients. Transplantation 2021; 105:2175-2183. [PMID: 34149003 PMCID: PMC8487707 DOI: 10.1097/tp.0000000000003860] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have described the clinical features of COVID-19 in solid-organ transplant recipients. However, many have been retrospective or limited to more severe cases (hospitalized) and have not routinely included serial virological sampling (especially in outpatients) and immunologic assessment. METHODS Transplant patients diagnosed with COVID-19 based on a respiratory sample PCR were prospectively followed up to 90 d. Patients provided consent for convalescent serum samples and serial nasopharyngeal swabs for SARS-CoV-2 antibody (antinucleoprotein and anti-RBD) and viral load, respectively. RESULTS In the 161 SOT recipients diagnosed with COVID-19, the spectrum of disease ranged from asymptomatic infection (4.3%) to hospitalization (60.6%), supplemental oxygen requirement (43.1%), mechanical ventilation (22.7%), and death (15.6%). Increasing age (OR, 1.031; 95% CI, 1.001-1.062; P = 0.046) and ≥2 comorbid conditions (OR, 3.690; 95% CI, 1.418-9.615; P = 0.007) were associated with the need for supplemental oxygen. Allograft rejection was uncommon (3.7%) despite immunosuppression modification. Antibody response at ≥14 d postsymptoms onset was present in 90% (anti-RBD) and 76.7% (anti-NP) with waning of anti-NP titers and stability of anti-RBD over time. Median duration of nasopharyngeal positivity was 10.0 d (IQR, 5.5-18.0) and shedding beyond 30 d was observed in 6.7% of patients. The development of antibody did not have an impact on viral shedding. CONCLUSIONS This study demonstrates the spectrum of COVID-19 illness in transplant patients. Risk factors for severe disease are identified. The majority form antibody by 2 wk with differential stability over time. Prolonged viral shedding was observed in a minority of patients. Reduction of immunosuppression was a safe strategy.
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Affiliation(s)
- Tina Marinelli
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Victor H. Ferreira
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Matthew Ierullo
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Terrance Ku
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Les Lilly
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - S. Joseph Kim
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Jeffrey Schiff
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Aman Sidhu
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Michael McDonald
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | | | - Shahid Husain
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Coleman Rotstein
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | | | - Vathany Kulasingam
- Department of Biochemistry, University Health Network, Toronto, ON, Canada
| | - Atul Humar
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Deepali Kumar
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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38
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Quante M, Brake L, Tolios A, Della Penna A, Steidle C, Gruendl M, Grishina A, Haeberle H, Guthoff M, Tullius SG, Königsrainer A, Nadalin S, Löffler MW. SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020. Transplant Proc 2021; 53:2421-2434. [PMID: 34551880 PMCID: PMC8364801 DOI: 10.1016/j.transproceed.2021.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, a huge number of case reports, case series, and consecutively various systematic reviews have been published reporting on morbidity and mortality risk connected with SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even for the expert reader. METHODS We performed a structured literature review comprising electronic databases, transplant journals, and literature from previous systematic reviews covering the entire year 2020. From 164 included articles, we identified 3451 cases of SARS-CoV-2-infected SOT recipients. RESULTS Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after coronavirus disease 2019 (COVID-19) was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT recipients. CONCLUSIONS COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT recipients with COVID-19.
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Affiliation(s)
- Markus Quante
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Linda Brake
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Tolios
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria; Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Vienna, Austria
| | - Andrea Della Penna
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Steidle
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Magdalena Gruendl
- Department of Epidemiology, Technical University Munich, Munich, Germany
| | - Anna Grishina
- Department of Pediatrics I, University Medicine Essen, Essen, Germany
| | - Helene Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Stefan G Tullius
- Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred Königsrainer
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Markus W Löffler
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany; Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany; Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany.
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Dogar AW, Uddin S, Ghaffar A, Abbas SH, Izzo H, Hussain A, Ullah K, Shoaib A, Ud Din S, Ahmed B, Hamza MA, Zafar M, Qaiser MA, Raza H, Baig MA, Husnain A, Mumtaz K. Challenges of continuation of live liver donor programme during COVID-19 pandemic in Pakistan: outcomes and lessons learned. BMJ Open Gastroenterol 2021; 8:e000723. [PMID: 34670755 PMCID: PMC8529618 DOI: 10.1136/bmjgast-2021-000723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has globally affected healthcare including the transplantation programmes. MATERIALS AND METHODS We retrospectively studied the impact of COVID-19 on live liver donor (LLD) programme at liver transplant centre in Gambat, Pakistan. Standard operative procedures (SOPs) including COVID-19 nasopharyngeal swab PCR, CT scans, personal protective equipment use, 6-feet distancing were developed for LLD and transplant team to mitigate COVID-19 exposure. We compared the complications, healthcare utilisation (hospital stay, readmission) and mortality between two LLD cohorts-before and during COVID-19 pandemic from March 2019 to December 2020. RESULTS During study period 300 LLD surgeries were performed. There was an increase in rate of LLDs from 132 (44%) in pre-COVID to 168 (56%) during COVID-19 era. Average numbers of transplants per month performed during pre-COVID and during COVID-19 era were 10.1 and 14, respectively. No donor has developed COVID-19 infection during hospitalisation. Rate of all LLD complications (32 (21.47%) and 49 (29.16%), p=0.43), uneventful discharges (120/168 (71.4%) and 88/132 (66.6%), p<0.05), mean hospital stay (6±2 days and 5±2 days, p=0.17) and readmission (5 (4%) and 3 (1.8%), p=0.43) were similar during the pre-COVID and COVID-19 era. No donor mortality was observed during study period. CONCLUSION With the implementation of mindful SOPs, rate of LLD increased without any case of COVID-19 infection. Our SOPs were helpful in continuation of LLD programme in a developing country during COVID-19 pandemic.
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Affiliation(s)
- Abdul Wahab Dogar
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Shams Uddin
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Abdul Ghaffar
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Syed Hasnain Abbas
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Hala Izzo
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Azhar Hussain
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
- Ameer-ud-Din Medical College of PGMI, Lahore, Pakistan
| | - Kaleem Ullah
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Azam Shoaib
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Siraj Ud Din
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Bilal Ahmed
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | | | - Munaza Zafar
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | | | - Hamid Raza
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Muhammad Asif Baig
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Ali Husnain
- Liver Transplant Unit, Gambat Institute of Medical Sciences, Gambat, Pakistan
| | - Khalid Mumtaz
- Ohio State University Foundation, Columbus, Ohio, USA
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Ribeiro Junior MAF, Costa CTK, Néder PR, Aveiro IDEA, Elias YGB, Augusto SDES. Impact of COVID-19 on the number of transplants performed in Brazil during the pandemic. Current situation. Rev Col Bras Cir 2021; 48:e20213042. [PMID: 34586206 PMCID: PMC10683411 DOI: 10.1590/0100-6991e-20213042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.
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Affiliation(s)
- Marcelo Augusto Fontenelle Ribeiro Junior
- - Pontifícia Universidade Católica de São Paulo - PUCSP-Sorocaba, Disciplina de Cirurgia Geral e Trauma - Sorocaba - SP - Brasil
- - Faculdade de Ciências Médicas de São José dos Campos - Humanitas - São José dos Campos - SP - Brasil
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Kute VB, Meshram HS, Patel HV, Engineer D, Banerjee S, Navadiya VV, Patel DD, Gupta A, Chauhan S, Mishra VV. Clinical Profiles and Outcomes of COVID-19 in Kidney Transplant Recipients: Experience From a High-Volume Public Sector Transplant Center in India. EXP CLIN TRANSPLANT 2021; 19:899-909. [PMID: 34545775 DOI: 10.6002/ect.2021.0188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Data are so far limited on outcomes of kidney transplant recipients with COVID-19 seen at public sector hospitals in developing countries with limited resources. MATERIALS AND METHODS We retrospectively investigated a cohort of 157 kidney transplant recipients (75% living and 25% deceased donors) seen at a public sector transplant hospital in India from March to December 2020 who had reverse-transcriptase polymerase chain reaction tests that confirmed COVID-19. Demographic data, immunosuppression regimens, clinical profiles, treatments, and outcomes were analyzed. In our center, maintenance immunosuppression was reduced according to disease severity and case-by-case evaluations. There were also 53 patients with asymptomatic or mild COVID-19 symptoms who received home care to optimize the utilization of scarce resources during travel restrictions. RESULTS In our kidney transplant recipient group, median age was 43 years (133 male; 24 female patients); recipients presented at a median of 4 years after transplant. The most common comorbidities included arterial hypertension (73%) and diabetes (24%); presenting symptoms at the time of COVID-19 positivity included cough (49%), fever (58%), and sputum production (32%). Clinical severity ranged from asymptomatic (4%), mild (45%), moderate (31%), and severe (20%) disease. Statistically significant risk factors for mortality included older age, dyspnea, severe disease, obesity, allograft dysfunction prior to COVID-19, acute kidney injury, higher levels of inflammatory markers (C-reactive protein, interleukin 6, procalcitonin), abnormality in chest radiography, and intensive care/ventilator requirements (P < .05). Overall patient mortality was 9.5% (15/157) in hospitalized patients, 21% (15/71) in patients in the intensive care unit, 100% (15/15) in patients who required ventilation, and 0% among those in home treatment. CONCLUSIONS The mortality rate in kidney transplant recipients with COVID-19 was higher than in the nonimmunosuppressed general population (1.2%) in India. To our knowledge, this is a largest single-center study of kidney transplant recipients with COVID-19 so far.
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Affiliation(s)
- Vivek B Kute
- From the Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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42
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Permpalung N, Bazemore K, Chiang TPY, Mathew J, Barker L, Nematollahi S, Cochran W, Sait AS, Avery RK, Shah PD. Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study. Transplantation 2021; 105:2072-2079. [PMID: 34075005 DOI: 10.1097/tp.0000000000003839] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
- Nitipong Permpalung
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Katrina Bazemore
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joby Mathew
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lindsay Barker
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Saman Nematollahi
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Willa Cochran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Afrah S Sait
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin K Avery
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pali D Shah
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Senefeld JW, Klassen SA, Ford SK, Senese KA, Wiggins CC, Bostrom BC, Thompson MA, Baker SE, Nicholson WT, Johnson PW, Carter RE, Henderson JP, Hartman WR, Pirofski L, Wright RS, Fairweather DL, Bruno KA, Paneth NS, Casadevall A, Joyner MJ. Use of convalescent plasma in COVID-19 patients with immunosuppression. Transfusion 2021; 61:2503-2511. [PMID: 34036587 PMCID: PMC8242637 DOI: 10.1111/trf.16525] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022]
Abstract
In the absence of effective countermeasures, human convalescent plasma has been widely used to treat severe acute respiratory syndrome coronavirus 2, the causative agent of novel coronavirus disease 19 (COVID-19), including among patients with innate or acquired immunosuppression. However, the association between COVID-19-associated mortality in patients with immunosuppression and therapeutic use of convalescent plasma is unknown. We review 75 reports, including one large matched-control registry study of 143 COVID-19 patients with hematological malignancies, and 51 case reports and 23 case series representing 238 COVID-19 patients with immunosuppression. We review clinical features and treatment protocols of COVID-19 patients with immunosuppression after treatment with human convalescent plasma. We also discuss the time course and clinical features of recovery. The available data from case reports and case series provide evidence suggesting a mortality benefit and rapid clinical improvement in patients with several forms of immunosuppression following COVID-19 convalescent plasma transfusion. The utility of convalescent plasma or other forms of antibody therapy in immune-deficient and immune-suppressed patients with COVID-19 warrants further investigation.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Stephen A. Klassen
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Shane K. Ford
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Katherine A. Senese
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Bruce C. Bostrom
- Pediatric Oncology and Hematology, Children's Hospital of MinnesotaMinneapolisMinnesotaUSA
| | | | - Sarah E. Baker
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Wayne T. Nicholson
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Patrick W. Johnson
- Department of Health Sciences Research, Mayo ClinicJacksonvilleFloridaUSA
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo ClinicJacksonvilleFloridaUSA
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - William R. Hartman
- Department of AnesthesiologyUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Liise‐anne Pirofski
- Division of Infectious Diseases, Department of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - R. Scott Wright
- Department of Cardiovascular Medicine and Director Human Research Protection ProgramMayo ClinicRochesterMinnesotaUSA
| | | | - Katelyn A. Bruno
- Department of Cardiovascular MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics and Department of Pediatrics and Human DevelopmentMichigan State UniversityEast LansingMichiganUSA
| | - Arturo Casadevall
- Department of Molecular Microbiology and ImmunologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
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44
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Avery RK, Chiang TPY, Marr KA, Brennan DC, Sait AS, Garibaldi BT, Shah P, Ostrander D, Steinke SM, Permpalung N, Cochran W, Makary MA, Garonzik-Wang J, Segev DL, Massie AB. Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: A retrospective cohort. Am J Transplant 2021; 21:2498-2508. [PMID: 33284498 PMCID: PMC9800757 DOI: 10.1111/ajt.16431] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/01/2020] [Accepted: 11/22/2020] [Indexed: 01/25/2023]
Abstract
Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < .001), hypertension (69% vs. 44%, p = .001), HIV (7% vs. 1.4%, p = .024), and peripheral vascular disorders (19% vs. 8%, p = .018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = .13), length-of-stay (sHR: 0.9 1.11.4 , p = .5), or mortality (sHR: 0.1 0.41.6 , p = .19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3-4]) (p = .042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = 0.76 0.810.86 , p < .001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.
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Affiliation(s)
- Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kieren A. Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afrah S. Sait
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian T. Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pali Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seema Mehta Steinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Willa Cochran
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin A. Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Kute VB, Ray DS, Yadav DK, Pathak V, Bhalla AK, Godara S, Kumar A, Guleria S, Khullar D, Thukral S, Mondal RRS, Jain M, Jha PK, Hegde U, Abraham M A, Dalal S, Patel H, Bahadur MM, Shingare A, Sharma A, Kumar Sharma R, Anandh U, Gulati S, Gumber M, Siddini V, Deshpande R, Kaswan K, Varyani U, Kakde S, Kenwar DB, Shankar Meshram H, Kher V. A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19. Transplantation 2021; 105:1423-1432. [PMID: 33724246 DOI: 10.1097/tp.0000000000003740] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil Kumar
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Dinesh Khullar
- Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Raj Kumar Sharma
- Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | | | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kamal Kaswan
- Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India
| | - Umesh Varyani
- Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Deepesh B Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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Soin AS, Choudhary NS, Yadav SK, Saigal S, Saraf N, Rastogi A, Bhangui P, Srinivasan T, Mohan N, Saha SK, Gupta A, Chaudhary RJ, Yadav K, Dhampalwar S, Govil D, Gupta N, Vohra V. Restructuring Living-Donor Liver Transplantation at a High-Volume Center During the COVID-19 Pandemic. J Clin Exp Hepatol 2021; 11:418-423. [PMID: 33052181 PMCID: PMC7543734 DOI: 10.1016/j.jceh.2020.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has led to deferral of elective transplants and proactive pretransplant testing of the donor/recipient. The impact of these on living-donor liver transplantation (LDLT) activity and outcome is not known. We performed LDLT only for sick patients or patients with advanced hepatocellular carcinoma in this period, with special COVID protocols. METHODS Patients undergoing LDLT counseling, evaluation, and transplant in the period March to June 2020 (group A) under COVID-19 restrictions and special protocols were included. LDLT activity and outcomes among these patients were compared with those in the same period in 2019 (group B). RESULTS In the period March 15-June 10, we performed 39 and 23 (59%) LDLTs in 2019 and 2020, respectively. The adult patients with cirrhosis in group A (n = 20) had a significantly higher MELD score, 19.8 ± 7.0 versus 16.1 ± 5.6 in group B (n = 36), p = 0.034. Early recipient mortality was similar in 2019 (2/39) and 2020 (2/23). One of 23 post-transplant recipients, 3/71 recipients and donors during evaluation, and 8/125 healthcare workers (HCWs) developed COVID-19, all of whom recovered uneventfully. CONCLUSION LDLT activity substantially reduced during the COVID era. The incidence and outcome of COVID-19 among the waiting or transplanted patients and HCWs were similar to those of the general population. The outcome after LDLT in the COVID era was similar to that in non-COVID times. These data suggest that LDLT may be extended to more stable patients with strict protocols.
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Affiliation(s)
- Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Narendra S. Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjay K. Yadav
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Amit Rastogi
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Thiagarajan Srinivasan
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Neelam Mohan
- Paediatric Gastroenterology and Hepatology, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Sujeet K. Saha
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Ankur Gupta
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Rohan J. Chaudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Kamal Yadav
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Swapnil Dhampalwar
- Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Deepak Govil
- Critical Care, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Nikunj Gupta
- Liver Transplant Anesthesia, Medanta the Medicity, Gurgaon, Delhi (NCR), India
| | - Vijay Vohra
- Liver Transplant Anesthesia, Medanta the Medicity, Gurgaon, Delhi (NCR), India
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Azzi Y, Brooks A, Yaffe H, Greenstein S. COVID-19 and the Response of Transplant Centers: the Global Response with an Emphasis on the Kidney Recipient. CURRENT TRANSPLANTATION REPORTS 2021; 8:163-182. [PMID: 34221847 PMCID: PMC8241407 DOI: 10.1007/s40472-021-00330-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW In response to the COVID-19 pandemic, vulnerable populations, such as transplant patients, were at greater risk than the regular population. In order to protect these populations, transplant centers enacted new guidelines. We approach this review by looking at how different transplant regions responded to COVID-19 and analyze the unifying themes that have proven invaluable in the subsequent waves. RECENT FINDINGS We noticed that most elective surgeries including living donor transplant operations were suspended in most countries. The response to deceased donor transplants varied between countries: in some deceased donor transplants continued with modified donor and recipient criteria, while in other countries this surgery was suspended. There was a general trend of decreasing or holding antimetabolites, treating the virus with hydroxychloroquine and/or azithromycin, and converting outpatient clinics to virtual clinics. SUMMARY We learned how to carefully select donors and recipients, tailor immunosuppressant regiments, and implement telemedicine. The kidney recipient population can be effectively managed in times of crisis with appropriate accommodations and measures. This review can be a model for the transplant community for future pandemics.
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Affiliation(s)
- Yorg Azzi
- Albert Einstein College of Medicine, Bronx, NY USA
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA
| | - Abigail Brooks
- Albert Einstein College of Medicine, Bronx, NY USA
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA
| | - Hillary Yaffe
- Albert Einstein College of Medicine, Bronx, NY USA
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA
| | - Stuart Greenstein
- Albert Einstein College of Medicine, Bronx, NY USA
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA
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Nopsopon T, Kittrakulrat J, Takkavatakarn K, Eiamsitrakoon T, Kanjanabuch T, Pongpirul K. Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009156. [PMID: 34129609 PMCID: PMC8232454 DOI: 10.1371/journal.pntd.0009156] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The 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 a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We 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. Of 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%. Conclusions This 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. Chronic 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 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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Affiliation(s)
- Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jathurong Kittrakulrat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanee Eiamsitrakoon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bumrungrad International Hospital, Bangkok, Thailand
- * E-mail:
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49
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Singer PS, Sethna C, Molmenti E, Fahmy A, Grodstein E, Castellanos‐Reyes L, Fassano J, Teperman L. COVID-19 infection in a pediatric kidney transplant population: A single-center experience. Pediatr Transplant 2021; 25:e14018. [PMID: 33813782 PMCID: PMC8250351 DOI: 10.1111/petr.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical course of SARS-CoV-2 in the pediatric kidney transplant population is not well described. METHODS We performed a retrospective cohort study of a pediatric kidney transplant population at a New York transplant center. Baseline characteristics and clinical course of patients with SARS-CoV-2 positivity (Ab or PCR) were described, and comparison between COVID-positive and COVID-negative transplant patients was performed. RESULTS Twenty-two patients had COVID-19 IgG testing performed, eight of whom also had PCR testing. 23% of our cohort had evidence of COVID-19 infection. Four patients had positive IgG only, and one patient had a positive PCR. All five patients with a positive COVID test were female. Two patients had COVID-19 symptoms, which were mild. Of the symptomatic patients, one had a positive PCR at time of symptoms, while the other had a negative PCR during symptoms but subsequently had positive IgG. As compared to patients with COVID-19 negative results, those with COVID-19 positivity were significantly more likely to have a known COVID-19 exposure, and were also more likely to be female. There was no significant difference in time from transplant between the groups. Those in the COVID-positive group had higher baseline antimetabolite dose and CNI troughs, although these did not reach statistical significance. CONCLUSIONS Pediatric kidney transplant recipients are at risk for development of COVID-19 infection. While this population may be more at risk for SARS-CoV-2 infection due to their immunosuppressed status, their clinical course appears mild and similar to a healthy pediatric population.
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Affiliation(s)
- Pamela S. Singer
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Pediatric NephrologyDepartment of PediatricsCohen Children's Medical CenterNorthwell HealthQueensNYUSA
| | - Christine Sethna
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Pediatric NephrologyDepartment of PediatricsCohen Children's Medical CenterNorthwell HealthQueensNYUSA
| | - Ernesto Molmenti
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Transplant SurgeryDepartment of SurgeryNorthwell HealthQueensNYUSA
| | - Ahmed Fahmy
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Transplant SurgeryDepartment of SurgeryNorthwell HealthQueensNYUSA
| | - Elliot Grodstein
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Transplant SurgeryDepartment of SurgeryNorthwell HealthQueensNYUSA
| | - Laura Castellanos‐Reyes
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Pediatric NephrologyDepartment of PediatricsCohen Children's Medical CenterNorthwell HealthQueensNYUSA
| | - Jessica Fassano
- Division of Pediatric NephrologyDepartment of PediatricsCohen Children's Medical CenterNorthwell HealthQueensNYUSA
| | - Lewis Teperman
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNYUSA,Division of Transplant SurgeryDepartment of SurgeryNorthwell HealthQueensNYUSA
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50
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Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS One 2021; 16:e0251170. [PMID: 33956882 PMCID: PMC8101968 DOI: 10.1371/journal.pone.0251170] [Citation(s) in RCA: 337] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/21/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. PATIENTS AND METHODS We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763. RESULTS Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95% CI: 19%-30%). Pooled prevalence of pathogen type stratified by co- or superinfection were: viral co-infections, 10% (95% CI: 6%-14%); viral superinfections, 4% (95% CI: 0%-10%); bacterial co-infections, 8% (95% CI: 5%-11%); bacterial superinfections, 20% (95% CI: 13%-28%); fungal co-infections, 4% (95% CI: 2%-7%); and fungal superinfections, 8% (95% CI: 4%-13%). Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31, 95% CI: 1.82-5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively). CONCLUSIONS Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.
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Affiliation(s)
- Jackson S. Musuuza
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
| | - Lauren Watson
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Vishala Parmasad
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Nathan Putman-Buehler
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Leslie Christensen
- Ebling Library for the Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America
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