COVID-19 in solid organ transplant recipients: Initial report from the US epicenter

Marcus R Pereira, Sumit Mohan, David J Cohen, Syed A Husain, Geoffrey K Dube, Lloyd E Ratner, Selim Arcasoy, Meghan M Aversa, Luke J Benvenuto, Darshana M Dadhania, Sandip Kapur, Lorna M Dove, Robert S Brown Jr, Russell E Rosenblatt, Benjamin Samstein, Nir Uriel, Maryjane A Farr, Michael Satlin, Catherine B Small, Thomas J Walsh, Rosy P Kodiyanplakkal, Benjamin A Miko, Justin G Aaron, Demetra S Tsapepas, Jean C Emond, Elizabeth C Verna, Marcus R Pereira, Sumit Mohan, David J Cohen, Syed A Husain, Geoffrey K Dube, Lloyd E Ratner, Selim Arcasoy, Meghan M Aversa, Luke J Benvenuto, Darshana M Dadhania, Sandip Kapur, Lorna M Dove, Robert S Brown Jr, Russell E Rosenblatt, Benjamin Samstein, Nir Uriel, Maryjane A Farr, Michael Satlin, Catherine B Small, Thomas J Walsh, Rosy P Kodiyanplakkal, Benjamin A Miko, Justin G Aaron, Demetra S Tsapepas, Jean C Emond, Elizabeth C Verna

Abstract

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.

Keywords: antibiotic: antiviral; clinical research/practice; complication: infectious; immunosuppression/immune modulation; infection and infectious agents - viral; infectious disease; organ transplantation in general.

© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.

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Source: PubMed

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