TY - JOUR
T1 - COVID-19 in solid organ transplant recipients
T2 - Initial report from the US epicenter
AU - Pereira, Marcus R.
AU - Mohan, Sumit
AU - Cohen, David J.
AU - Husain, Syed A.
AU - Dube, Geoffrey K.
AU - Ratner, Lloyd E.
AU - Arcasoy, Selim
AU - Aversa, Meghan M.
AU - Benvenuto, Luke J.
AU - Dadhania, Darshana M.
AU - Kapur, Sandip
AU - Dove, Lorna M.
AU - Brown, Robert S.
AU - Rosenblatt, Russell E.
AU - Samstein, Benjamin
AU - Uriel, Nir
AU - Farr, Maryjane A.
AU - Satlin, Michael
AU - Small, Catherine B.
AU - Walsh, Thomas J.
AU - Kodiyanplakkal, Rosy P.
AU - Miko, Benjamin A.
AU - Aaron, Justin G.
AU - Tsapepas, Demetra S.
AU - Emond, Jean C.
AU - Verna, Elizabeth C.
N1 - Funding Information:
SAH is supported by the NCATS (KL2 TR001874). SM is supported by NIDDK (R01 DK114893 and U01 DK116066) and NIMHD (R01 MD14161).
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.
AB - Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.
KW - antibiotic: antiviral
KW - clinical research/practice
KW - complication: infectious
KW - immunosuppression/immune modulation
KW - infection and infectious agents – viral
KW - infectious disease
KW - organ transplantation in general
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U2 - 10.1111/ajt.15941
DO - 10.1111/ajt.15941
M3 - Article
C2 - 32330343
AN - SCOPUS:85084420450
SN - 1600-6135
VL - 20
SP - 1800
EP - 1808
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -