1
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Copeland H, Baran DA, Morton J, Rodriguez V, Fernandes E, Mohammed A. Veno-venous ECLS rescue for a heart transplant recipient with COVID-19, a case report. Perfusion 2024; 39:631-634. [PMID: 36715461 PMCID: PMC9892811 DOI: 10.1177/02676591231154120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The potential for increased rates of morbidity of SARS-CoV-2 within immunocompromised populations has been of concern since the pandemic's onset. Transplant providers and patients can face particularly challenging situations, in the current settings as data continues to emerge for the prevention and treatment of the immunocompromised subpopulation. This case report details a patient 9-months post orthotopic heart transplant that developed SARS-CoV-2 infection despite two prior doses of the Pfizer-BioNtech COVID-19 vaccine, and had successful rescue from refractory hypoxemia with veno-venous extracorporeal membrane oxygenation (VV ECLS).
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Affiliation(s)
- Hannah Copeland
- Division of Cardiothoracic and Vascular Surgery, Surgical Director Heart Transplant, Mechanical Circulatory Support and ECMO, Lutheran Hospital, Indiana University School of Medicine - Fort Wayne (IUSM-FW), Fort Wayne, IN, USA
| | - David A Baran
- Advanced Heart Failure, Transplant and MCS, Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, FL, USA
| | - John Morton
- Division of Cardiothoracic and Vascular Surgery, Lutheran Hospital, Fort Wayne, IN, USA
| | - Vicente Rodriguez
- Division of Pulmonary Critical Care, Lutheran Hospital, Fort Wayne, IN, USA
| | - Eustace Fernandes
- Division of Pulmonary Critical Care, Lutheran Hospital, Fort Wayne, IN, USA
| | - Asim Mohammed
- Division of Cardiology, Advanced Heart Failure, Medical Director of Heart Transplant and Mechanical Circulatory Support, Lutheran Hospital, Fort Wayne, IN, USA
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2
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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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3
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Hashem M, El-Kassas M. Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19. World J Clin Cases 2023; 11:2140-2159. [PMID: 37122505 PMCID: PMC10131019 DOI: 10.12998/wjcc.v11.i10.2140] [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: 09/02/2022] [Revised: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.
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Affiliation(s)
- Mai Hashem
- Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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4
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Garcia LR, Garzesi AM, Sinatora JB, Grotto RMT, Passaroni AC, de Campos NLKL, Martins AS, Felicio ML, Brito FDS. Orthotopic Heart Transplantation in a Covid-19 Recipient. Arq Bras Cardiol 2023; 120:e20220234. [PMID: 37018788 PMCID: PMC10392859 DOI: 10.36660/abc.20220234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 04/07/2023] Open
Affiliation(s)
- Leonardo Rufino Garcia
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - André Monti Garzesi
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Julia Bazzo Sinatora
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Rejane Maria Tommasini Grotto
- Laboratório de Biotecnologia AplicadaHospital das Clínicas de BotucatuUNESPBotucatuSPBrasilLaboratório de Biotecnologia Aplicada do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Andréia Cristina Passaroni
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Nelson Leonardo Kerdahi Leite de Campos
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Antônio Sérgio Martins
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Marcello Laneza Felicio
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Flávio de Souza Brito
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
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5
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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6
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Ilonze OJ, Ballut K, Rao RS, Jones MA, Guglin M. SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies. Heart Fail Rev 2022; 27:1653-1663. [PMID: 34671872 PMCID: PMC8528562 DOI: 10.1007/s10741-021-10181-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
The impact of SARS-CoV-2 infection on heart transplant recipients is unknown. Literature is limited to case reports and series. The purpose of this study is to identify the clinical features, outcomes, and immunosuppression strategies of heart transplant recipients with COVID-19 infection. A systematic review was conducted using the search term "Coronavirus" or COVID," "SARS-CoV-2," "cardiac transplantation," and "heart transplant." Case reports and retrospective studies were gathered by searching Medline/PubMed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science. Thirty-three articles were selected for review. We identified 74 cases of SARS-CoV-2 infection in heart transplant and heart-kidney transplant recipients. The mean age was 60.5 ± 15.8 years, and 82.4% were males with median time from transplant of 6.5 years. Commonest symptoms were fever, cough, and dyspnea, but new left ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated inflammatory markers, and bilateral ground-glass opacities were common. Mortality was high, with particularly poor survival in patients who required intensive care unit (ICU) admission and older patients. Immunosuppression involved discontinuation of antimetabolites and steroids. COVID-19 infection in heart transplant (HT) recipients presents similarly to the general population, but new onset of LV dysfunction is uncommon. Immunosuppression strategies include increase in corticosteroids and discontinuation of antimetabolites.
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Affiliation(s)
- Onyedika J. Ilonze
- Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA
- Indianapolis, USA
| | - Kareem Ballut
- Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA
| | - Roopa S. Rao
- Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA
| | - Mark A. Jones
- Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA
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7
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Martits-Chalangari K, Spak CW, Askar M, Killian A, Fisher TL, Atillasoy E, Marshall WL, McNeel D, Miller MD, Mathai SK, Gottlieb RL. ALVR109, an off-the-shelf partially HLA matched SARS-CoV-2-specific T cell therapy, to treat refractory severe COVID-19 pneumonia in a heart transplant patient: Case report. Am J Transplant 2022; 22:1261-1265. [PMID: 34910857 PMCID: PMC9303326 DOI: 10.1111/ajt.16927] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 12/10/2021] [Indexed: 01/25/2023]
Abstract
An unvaccinated adult male heart transplant recipient patient with recalcitrant COVID-19 due to SARS-CoV-2 delta variant with rising nasopharyngeal quantitative viral load was successfully treated with ALVR109, an off-the-shelf SARS-CoV-2-specific T cell therapy. Background immunosuppression included 0.1 mg/kg prednisone, tacrolimus, and mycophenolate mofetil 1 gm twice daily for historical antibody-mediated rejection. Prior therapies included remdesivir, corticosteroids, and tocilizumab, with requirement for high-flow nasal oxygen. Lack of clinical improvement and acutely rising nasopharyngeal viral RNA more than 3 weeks into illness prompted the request of ALVR109 through an emergency IND. The day following the first ALVR109 infusion, the patient's nasopharyngeal SARS-CoV-2 RNA declined from 7.43 to 5.02 log10 RNA copies/ml. On post-infusion day 4, the patient transitioned to low-flow oxygen. Two subsequent infusions of ALVR109 were administered 10 and 26 days after the first; nasopharyngeal SARS-CoV-2 RNA became undetectable on Day 11, and he was discharged the following day on low-flow oxygen 5 weeks after the initial diagnosis of COVID-19. The clinical and virologic improvements observed in this patient following administration of ALVR109 suggest a potential benefit that warrants further exploration in clinical trials.
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Affiliation(s)
- Katalin Martits-Chalangari
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Cedric W. Spak
- Baylor University Medical Center, Dallas, Texas, USA,Texas A&M Health Science Center, Dallas, Texas, USA
| | - Medhat Askar
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA,Texas A&M Health Science Center, Dallas, Texas, USA
| | - Aaron Killian
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Tammy L. Fisher
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA
| | | | | | | | | | - Susan K. Mathai
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA,Texas A&M Health Science Center, Dallas, Texas, USA
| | - Robert L. Gottlieb
- Baylor University Medical Center, Dallas, Texas, USA,Baylor Scott & White Research Institute, Dallas, Texas, USA,Texas A&M Health Science Center, Dallas, Texas, USA,TCU and University of North Texas Health Science Center, Fort Worth, Texas, USA,Correspondence Robert L. Gottlieb, Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA.
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8
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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: 13] [Impact Index Per Article: 6.5] [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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9
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Zetina-Tun HJ, Careaga-Reyna G. Infección por SARS-CoV-2 en pacientes trasplantados de corazón. Experiencia en México. CIRUGIA CARDIOVASCULAR 2022. [PMCID: PMC8226102 DOI: 10.1016/j.circv.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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10
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Yılmaz EA, Özdemir Ö. Solid organ transplantations and COVID-19 disease. World J Transplant 2021; 11:503-511. [PMID: 35070786 PMCID: PMC8713305 DOI: 10.5500/wjt.v11.i12.503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/04/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Tens of thousands of people worldwide became infected with severe acute respiratory syndrome coronavirus-2. Death rate in the general population is about 1%-6%, but this rate rises up to 15% in those with comorbidities. Recent publications showed that the clinical progression of this disease in organ recipients is more destructive, with a fatality rate of up to 14%-25%. We aimed to review the effect of the pandemic on various transplantation patients. Coronavirus disease 2019 (COVID-19) has not only interrupted the lives of waiting list patients’; it has also impacted transplantation strategies, transplant surgeries and broken donation chains. COVID-19 was directly and indirectly accountable for a 73% surplus in mortality of this population as compared to wait listed patients in earlier years. The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients. It is hard to endorse changing anti-rejection therapy, as the existing data evaluation is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.
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Affiliation(s)
- Emine Aylin Yılmaz
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
| | - Öner Özdemir
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
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11
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Ito T, Kenmochi T, Ota A, Kuramitsu K, Soyama A, Kinoshita O, Eguchi S, Yuzawa K, Egawa H. National survey on deceased donor organ transplantation during the COVID-19 pandemic in Japan. Surg Today 2021; 52:763-773. [PMID: 34686930 PMCID: PMC8536472 DOI: 10.1007/s00595-021-02388-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE We investigated the status of deceased organ donation and transplantation through a questionnaire distributed to transplant centers in Japan during the COVID-19 pandemic. METHODS The questionnaire was distributed electronically to 206 transplant centers for heart (n = 11), lung (n = 10), liver (n = 25), kidney (n = 130), pancreas (n = 18), and small intestine (n = 12) transplantation. Organ donations and organ transplantation data were extracted from the Japan Organ Transplant Network website. RESULTS We received questionnaire responses from 177 centers (response rate, 86%). In 2020, the number of brain-dead donors (BDDs) decreased to 68 (69% of the year-on-year average) and the number of donors after cardiac death (DCDs) decreased to 9 (32% of the year-on-year average). Eighty-five (48%) transplant centers (heart, n = 0; lung, n = 0; liver, n = 4; kidney, n = 78; pancreas, n = 22; and small intestine, n = 0) suspended transplant surgeries in response to the COVID-19 pandemic. Consequently, the number of organ transplantations from deceased donors was significantly lower in 2020 than in 2019. CONCLUSION Although the COVID-19 pandemic has had less impact in Japan than in other countries, it has affected transplantation activity significantly, suspending transplantation surgeries in 48% of the transplantation centers, including 78% of the kidney transplantation centers, and reducing the number of organ donations to 61% of the year-on-year average.
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Affiliation(s)
- Taihei Ito
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kaori Kuramitsu
- Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Mito, Ibaraki, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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12
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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: 2.3] [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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13
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Kittleson MM, Chambers DC, Cypel M, Potena L. Covid-19 in recipients of heart and lung transplantation: Learning from experience. J Heart Lung Transplant 2021; 40:948-950. [PMID: 34246563 PMCID: PMC8188768 DOI: 10.1016/j.healun.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Daniel C Chambers
- School of Clinical Medicine, The University of Queensland and Queensland Lung Transplant Program, Brisbane, Australia
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Luciano Potena
- Heart Failure and Transplant Program, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
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14
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Diaz‐Arocutipa C, Carvallo‐Castañeda D, Luis‐Ybañez O, Pariona M, Rivas‐Lasarte M, Álvarez‐García J. COVID-19 in heart transplant recipients during February-August 2020: A systematic review. Clin Transplant 2021; 35:e14390. [PMID: 34159650 PMCID: PMC8420345 DOI: 10.1111/ctr.14390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a major concern in immunosuppressed patients such as heart transplant recipients. Therefore, we performed a systematic review to summarize the clinical features, treatment, and outcomes of heart transplant recipients with COVID-19. We searched electronic databases from inception to January 11, 2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415 patients were included. The mean age was 59.9 ± 15.7 years and 77% of patients were men. In cohort studies including outpatients and inpatients, the hospitalization rate was 77%. The most common symptoms were fever (70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and procalcitonin) were above the normal range. Forty-eight percent of patients presented with severe or critical COVID-19. Hydroxychloroquine (54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most commonly used drugs. Forty-nine percent of patients discontinued the baseline regimen of antimetabolites. In contrast, 59% and 73% continued the same regimen of calcineurin inhibitors and corticosteroids, respectively. Short-term mortality among cohorts limited to inpatients was 25%. Our review suggests that heart transplant recipients with COVID-19 exhibited similar demographic and clinical features to the general population. However, the prognosis was poor in these patients.
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Affiliation(s)
- Carlos Diaz‐Arocutipa
- Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
- Programa de Atención Domiciliaria (PADOMI) – EsSaludLimaPeru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
| | - Darla Carvallo‐Castañeda
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Puesto de Salud PacaycasaMinisterio de SaludAyacuchoPeru
| | - Odalis Luis‐Ybañez
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Facultad de Medicina de San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
| | - Marcos Pariona
- Departamento de CardiologíaHospital Nacional Edgardo Rebagliati MartinsLimaPeru
| | - Mercedes Rivas‐Lasarte
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante CardiacoHospital Universitario Puerta de HierroMadridSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Jesús Álvarez‐García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
- Unidad de Insuficiencia Cardíaca Avanzada. Servicio de Cardiología del Hospital Universitario Ramón y CajalMadridSpain
- Universidad Autónoma de BarcelonaBarcelonaSpain
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15
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Hallett AM, Greenberg RS, Boyarsky BJ, Shah PD, Ou MT, Teles AT, Krach MR, López JI, Werbel WA, Avery RK, Bae S, Tobian AA, Massie AB, Higgins RSD, Garonzik-Wang JM, Segev DL, Bush EL. SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients. J Heart Lung Transplant 2021; 40:1579-1588. [PMID: 34456108 PMCID: PMC8349311 DOI: 10.1016/j.healun.2021.07.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p < .001). Priming dose antibody response was associated with younger recipient age (p = .04), transplant-to-vaccination time ≥6 years (p < .01), and lack of anti-metabolite maintenance immunosuppression (p < .001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.
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Affiliation(s)
- Andrew M Hallett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ross S Greenberg
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali D Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aura T Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle R Krach
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia I López
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A Tobian
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S D Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Errol L Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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16
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Amabile A, Geirsson A. Heart transplantations amidst the COVID-19 pandemic: "In the midst of chaos, there is also opportunity". J Card Surg 2021; 36:3222-3223. [PMID: 34101903 PMCID: PMC8242748 DOI: 10.1111/jocs.15732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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17
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Genuardi MV, Moss N, Najjar SS, Houston BA, Shore S, Vorovich E, Atluri P, Molina M, Chambers S, Sharkoski T, Hsich E, Estep JD, Owens AT, Alexander KM, Chaudhry SP, Garcia-Cortes R, Molina E, Rodrigo M, Wald MDJ, Margulies KB, Hanff TC, Zimmer R, Kilic A, Mclean R, Vidula H, Dodd K, Blumberg EA, Mazurek JA, Goldberg LR, Alvarez-Garcia J, Mancini D, Teuteberg JJ, Tedford RJ, Birati EY. Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes. J Heart Lung Transplant 2021; 40:926-935. [PMID: 34140222 PMCID: PMC8131557 DOI: 10.1016/j.healun.2021.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. Methods We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. Results The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. Conclusions We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
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Affiliation(s)
- Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Noah Moss
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor, MI
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Pavan Atluri
- Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania
| | - Maria Molina
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffany Sharkoski
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - MDc Joyce Wald
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rhondalyn Mclean
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Katherine Dodd
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Emily A Blumberg
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesus Alvarez-Garcia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Center, Bar Ilan University, Israel
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18
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Gilliland S, Tran T, Alber S, Krause M, Weitzel N. Year in Review 2020: Noteworthy Literature in Cardiothoracic Critical Care. Semin Cardiothorac Vasc Anesth 2021; 25:128-137. [PMID: 33988043 DOI: 10.1177/10892532211016167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This year will be forever marked by the drastic changes COVID-19 wrought on our personal and professional lives. New roles and challenges in critical care have forced us to be constantly nimble and flexible in how we approach medicine. The strain of these challenges is apparent throughout the health care community and our society as a whole. Despite this adversity, 2020 will also be remembered for fantastic advances in research. This article is a collection of influential and exciting studies published in 2020 encompassing a broad swath of critical care with a focus on cardiothoracic critical care. Themes include examinations of early extracorporeal membrane oxygenation support for out-of-hospital cardiac arrest patients, the impact of sedation and other risk factors on perioperative mortality, a novel fluid resuscitation strategy following cardiac surgery, and advances in the fields of heart and lung transplantation as well as how they were affected by COVID-19. Given that many cardiothoracic intensivists were redeployed to the care of SARS-CoV-2 patients, we also discuss important advances in therapeutics for the virus.
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19
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Roest S, Brugts JJ, van Kampen JJA, von der Thüsen JH, Constantinescu AA, Caliskan K, Hirsch A, Manintveld OC. COVID-19-related myocarditis post-heart transplantation. Int J Infect Dis 2021; 107:34-36. [PMID: 33862215 PMCID: PMC8056480 DOI: 10.1016/j.ijid.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
This report describes the first heart transplantation recipient with acute biventricular heart failure symptoms caused by a post-myocarditis state, late after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No other viral pathogens could be detected. Computed tomography angiography did not show cardiac allograft vasculopathy, and myocardial biopsy demonstrated no clinically relevant rejection. Subsequent cardiovascular magnetic resonance imaging revealed extensive epicardial delayed enhancement without myocardial edema. Heart failure medication was initiated and an implantable cardioverter defibrillator was implanted (due to non-sustained ventricular tachycardias), leading to a partial recovery of the ejection fraction. Further studies are needed to investigate the number of heart transplant recipients with myocardial damage after a SARS-CoV-2 infection.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen J A van Kampen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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20
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Granger C, Guedeney P, Arnaud C, Guendouz S, Cimadevilla C, Kerneis M, Kerneis C, Zeitouni M, Verdonk C, Legeai C, Lebreton G, Leprince P, Désiré E, Sorrentino S, Silvain J, Montalescot G, Hazan F, Varnous S, Dorent R. Clinical manifestations and outcomes of coronavirus disease-19 in heart transplant recipients: a multicentre case series with a systematic review and meta-analysis. Transpl Int 2021; 34:721-731. [PMID: 33539616 PMCID: PMC8014589 DOI: 10.1111/tri.13837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow-up of 54 (19-80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C-reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3-centre HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta-analysis including 4 studies, pre-existing diabetes mellitus (OR 3.60, 95% CI 1.43-9.06, I2 = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31, I2 = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID-19 in HT recipients.
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Affiliation(s)
- Camille Granger
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Paul Guedeney
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Camille Arnaud
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Soulef Guendouz
- Département de CardiologieHôpital Henri‐MondorAssistance Publique‐Hôpitaux de ParisCréteilFrance
| | - Claire Cimadevilla
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Mathieu Kerneis
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Caroline Kerneis
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Michel Zeitouni
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Constance Verdonk
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Camille Legeai
- Agence de la BiomédecineDirection Prélèvement Greffe Organes‐TissusSaint Denis La PlaineFrance
| | - Guillaume Lebreton
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Pascal Leprince
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Eva Désiré
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Sabato Sorrentino
- Division of CardiologyDepartment of Medical and Surgical SciencesURT National Research Council (CNR)Magna Graecia UniversityCatanzaroItaly
| | - Johanne Silvain
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Gilles Montalescot
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Fanny Hazan
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Shaida Varnous
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Richard Dorent
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
- Agence de la BiomédecineDirection Prélèvement Greffe Organes‐TissusSaint Denis La PlaineFrance
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21
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Danziger-Isakov L, Blumberg EA, Manuel O, Sester M. Impact of COVID-19 in solid organ transplant recipients. Am J Transplant 2021; 21:925-937. [PMID: 33319449 PMCID: PMC9800718 DOI: 10.1111/ajt.16449] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exploded onto the world stage in early 2020. The impact on solid organ transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on health care by the pandemic also disrupted transplant systems. We address the impact of COVID-19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID-19 in SOT recipients.
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Affiliation(s)
- Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily A. Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
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22
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Ballout JA, Ahmed T, Kolodziej AR. COVID-19 and Heart Transplant: A Case Series and Review of the Literature. Transplant Proc 2021; 53:1219-1223. [PMID: 33795149 PMCID: PMC7904448 DOI: 10.1016/j.transproceed.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in many challenges in patient care, especially among high-risk populations such as heart transplant recipients. Patients with heart transplant experience a significantly higher mortality rate with COVID-19 infection, and management is based on extrapolation from clinical trials done on nontransplant patients and from clinical experience. Here we report 4 cases of patients with heart transplant who presented with COVID-19 infection in late 2020. Patients presented with symptoms similar to those seen in the general population. All 4 patients were admitted to the hospital, and they were all treated with dexamethasone. In addition, 2 patients received remdesivir. Immunosuppressive medications were adjusted to maintain adequate levels of immunosuppression but at the same time allow for an adequate immune response against the infection. All patients were discharged alive from the hospital. We then performed a literature review on studies that included heart transplant patients who developed the infection and developed suggestions for a standardized management approach, which we share in this article.
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Affiliation(s)
- Jad A Ballout
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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23
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Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources' Allocation. Transplant Direct 2021; 7:e669. [PMID: 34113712 PMCID: PMC8184017 DOI: 10.1097/txd.0000000000001115] [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] [Received: 08/28/2020] [Revised: 10/31/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Solid organ transplants (SOTs) are life-saving interventions, recently challenged by coronavirus disease 2019 (COVID-19). SOTs require a multistep process, which can be affected by COVID-19 at several phases.
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24
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Raja MA, Mendoza MA, Villavicencio A, Anjan S, Reynolds JM, Kittipibul V, Fernandez A, Guerra G, Camargo JF, Simkins J, Morris MI, Abbo LA, Natori Y. COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature. Transplant Rev (Orlando) 2021; 35:100588. [PMID: 33246166 PMCID: PMC7666542 DOI: 10.1016/j.trre.2020.100588] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection from January 1st t October 9th, 2020. Pooled incidence of symptoms, treatments and outcomes were assessed. Two hundred and fifteen studies were included for systematic review and 60 for meta-analysis. We identified 2,772 unique SOT recipients including 1,500 kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms were fever and cough in 70.2% and 63.8% respectively. Majority (81%) required hospital admission. Immunosuppressive medications, especially antimetabolites, were decreased in 76.2%. Hydroxychloroquine and interleukin six antagonists were administered in59.5% and 14.9% respectively, while only few patients received remdesivir and convalescent plasma. Intensive care unit admission was 29% from amongst hospitalized patients. Only few studies reported secondary infections. Overall mortality was 18.6%. Our analysis shows a high incidence of hospital admission in SOT recipients with SARS-CoV-2 infection. As management of SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients should be assessed in future studies.
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Affiliation(s)
- Mohammed A Raja
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria A Mendoza
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aasith Villavicencio
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - John M Reynolds
- Department of Health Informatics, Calder Memorial Library, University of Miami Miller School of Medicine Miami, FL, USA
| | - Veraprapas Kittipibul
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anmary Fernandez
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA; Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Jose F Camargo
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - Michele I Morris
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilian A Abbo
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA
| | - Yoichiro Natori
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA.
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25
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Azzi Y, Bartash R, Scalea J, Loarte-Campos P, Akalin E. COVID-19 and Solid Organ Transplantation: A Review Article. Transplantation 2021; 105:37-55. [PMID: 33148977 DOI: 10.1097/tp.0000000000003523] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus pandemic has significantly impacted solid organ transplantation (SOT). Early in the outbreak period, transplant societies recommended suspending living kidney transplant programs in communities with widespread transmission to avoid exposing recipients to increased risk of immunosuppression, while recommendations were made to reserve deceased-donor kidney transplantation for likely life-saving indications. SOT recipients may be at high risk from COVID-19 disease due to chronic immunosuppressive treatment and other medical comorbidities. Mortality rates reported between 13 to over 30% in SOT recipients. In addition to high rates of complications and mortality attributable to COVID-19 infections, the pandemic has also led to additional complexities in transplantation including new questions regarding screening of donors and recipients, decision making to accept a patient for kidney transplant or wait after pandemic. The clinical implications of COVID-19 infection may also differ depending on the type of the transplanted organ and recipient comorbidities which further impacts decisions on continuing transplantation during the pandemic. Transplant activity during a pandemic should be tailored with careful selection of both donors and recipients. Furthermore, while tremendous strides have been made in treatment strategies and vaccinations, the impact of these in transplant recipients may be attenuated in the setting of their immunosuppression. In this review, we aim to summarize several aspects of COVID-19 in transplantation, including the immune response to SARS-CoV-2, SARS-CoV-2 diagnostics, clinical outcomes in SOT recipients, and end-stage kidney disease patients, transplant activity during the pandemic, and treatment options for COVID-19 disease.
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Affiliation(s)
- Yorg Azzi
- Division of Nephrology, Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Rachel Bartash
- Division of infectious Disease, Montefiore Medical Center Transplant Center, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph Scalea
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD
| | - Pablo Loarte-Campos
- Division of Nephrology, Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Enver Akalin
- Division of Nephrology, Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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26
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Shah JZ, Elbdri S, Patel AA, Badr AMH. SARS-CoV-2 Infection in the Heart Transplant Recipient. Heart Views 2020; 21:220-224. [PMID: 33688415 PMCID: PMC7899000 DOI: 10.4103/heartviews.heartviews_155_20] [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: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/08/2022] Open
Abstract
Review of the literature and reported case series has not reported an increased risk of SARS-CoV-2 infection in heart transplant recipients. However, this population is at increased risk of a more severe infection with increased mortality because of age and the presence of multiple comorbid conditions There is no significant difference in presenting symptoms in transplant recipients as compared to nontransplant patients, although diarrhea has been reported to be more frequent in transplant patients, a common side effect of immunosuppressive medications. Standard preventive measures have been shown to be equally protective in heart transplant recipients. Risk factors for severe disease and mortality are similar in both transplant recipients and nontransplant patients and include older age and the presence of comorbidities hypertension being the most common. The SARS-CoV-2 infection did not increase the risk of transplant allograft rejection. Currently, there are no specific treatment recommendations for SARS-CoV-2 infection in transplant recipients. However, the International Society of Heart and Lung and Transplant has issued guidance on how to modulate immunosuppressive therapy during SARS-CoV-2 infection.
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Affiliation(s)
- Jassim Zaheen Shah
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salah Elbdri
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Ahmad Patel
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amr Mohamed Hamed Badr
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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