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Mikhailov M, Budde K, Halleck F, Eleftheriadis G, Naik MG, Schrezenmeier E, Bachmann F, Choi M, Duettmann W, von Hoerschelmann E, Koch N, Liefeldt L, Lücht C, Straub-Hohenbleicher H, Waiser J, Weber U, Zukunft B, Osmanodja B. COVID-19 Outcomes in Kidney Transplant Recipients in a German Transplant Center. J Clin Med 2023; 12:6103. [PMID: 37763043 PMCID: PMC10531713 DOI: 10.3390/jcm12186103] [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: 08/10/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. We analyzed COVID-19 incidence and clinical outcomes in a single-center cohort of approximately 2500 KTRs. Between 1 February 2020 and 1 July 2022, 578 KTRs were infected with SARS-CoV-2, with 25 (4%) recurrent infections. In total, 208 KTRs (36%) were hospitalized, and 39 (7%) died. Among vaccinated patients, infection with the Omicron variant had a mortality of 2%. Unvaccinated patients infected with the Omicron variant showed mortality (9% vs. 11%) and morbidity (hospitalization 52% vs. 54%, ICU admission 12% vs. 18%) comparable to the pre-Omicron era. Multivariable analysis revealed that being unvaccinated (OR = 2.15, 95% CI [1.38, 3.35]), infection in the pre-Omicron era (OR = 3.06, 95% CI [1.92, 4.87]), and higher patient age (OR = 1.04, 95% CI [1.03, 1.06]) are independent risk factors for COVID-19 hospitalization, whereas a steroid-free immunosuppressive regimen was found to reduce the risk of COVID-19 hospitalization (OR = 0.51, 95% CI [0.33, 0.79]). This suggests that both virological changes in the Omicron variant and vaccination reduce the risk for morbidity and mortality from COVID-19 in KTRs. Our data extend the knowledge from the general population to KTRs and provide important insights into outcomes during the Omicron era.
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Affiliation(s)
- Michael Mikhailov
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
- Clinic for Anaesthesiology and Intensive Care Medicine, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Georgios Eleftheriadis
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Marcel G. Naik
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Friederike Bachmann
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Wiebke Duettmann
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Ellen von Hoerschelmann
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Nadine Koch
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Lutz Liefeldt
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Christian Lücht
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Henriette Straub-Hohenbleicher
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Johannes Waiser
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Ulrike Weber
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Bianca Zukunft
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
| | - Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.B.); (F.H.); (G.E.); (M.G.N.); (E.S.); (F.B.); (M.C.); (W.D.); (E.v.H.); (N.K.); (L.L.); (C.L.); (H.S.-H.); (J.W.); (U.W.); (B.Z.); (B.O.)
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Bachmann F, Budde K, Suttorp N, Lingscheid T, Stegemann MS, Osmanodja B, Schrezenmeier E, Duettmann W, Weber U, Naik M, Lehner LJ, Kahl A, Duerr M, Eckardt KU, Waiser J, Choi M, Halleck F. Initial Experience With SARS-CoV-2-Neutralizing Monoclonal Antibodies in Kidney or Combined Kidney-Pancreas Transplant Recipients. Transpl Int 2022; 35:10109. [PMID: 35431640 PMCID: PMC9008834 DOI: 10.3389/ti.2022.10109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
Abstract
Background: Antiviral drugs have shown little impact in patient infected with acute respiratory coronavirus 2 (SARS-CoV-2). Especially for immunocompromised persons positive for SARS-CoV-2, novel treatments are warranted. Recently, the U.S. FDA has granted an emergency use authorization (EUA) to two monoclonal antibodies (mAb) targeting the viral spike protein: bamlanivimab and casivirimab and imdevimab. As per the EUA, all SARS-CoV-2 positive organ transplant recipients can receive mAb treatment. Patients and methods: We queried our center's transplant registry to identify SARS-CoV-2 infected recipients treated with single doses of either Bamlanivimab or casivirimab/imdevimab up to May 31, 2021. We analyzed clinical outcomes, renal function and virus-specific antibodies. The co-primary endpoints were hospitalization due to COVID-19 and SARS-CoV-2 RT-PCR negativity. Results: Thirteen patients at a median interval of 55 (IQR, 26-110) months from transplant were treated: 8 with bamlanivimab and 5 with casivirimab/imdevimab. In all, 4/13 (31%) patients were hospitalized at some time, while 11/13 (85%) achieved PCR negativity. 2/4 hospitalized patients received mAb as rescue treatment. Overall mortality was 23%, with one death attributable to transplant-associated lymphoma. All six patients infected with the B 1.1.7 variant were alive at last contact. Conclusion: mAb treatment appears effective when administered early to SARS-CoV-2-infected transplant recipients.
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Affiliation(s)
- Friederike Bachmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tilman Lingscheid
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Miriam Songa Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Academy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wiebke Duettmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Weber
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcel Naik
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lukas Johannes Lehner
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Kahl
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Duerr
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Waiser
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Papalois V, Kotton CN, Budde K, Torre-Cisneros J, Croce D, Halleck F, Roze S, Grossi P. Impact of COVID-19 on Global Kidney Transplantation Service Delivery: Interim Report. Transpl Int 2022; 35:10302. [PMID: 35418803 PMCID: PMC8996250 DOI: 10.3389/ti.2022.10302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
This article gives a personal, historical, account of the impact of the COVID-19 pandemic on transplantation services. The content is based on discussions held at two webinars in November 2020, at which kidney transplantation experts from prestigious institutions in Europe and the United States reflected on how the pandemic affected working practices. The group discussed adaptations to clinical care (i.e., ceasing, maintaining and re-starting kidney transplantations, and cytomegalovirus infection management) across the early course of the pandemic. Discussants were re-contacted in October 2021 and asked to comment on how transplantation services had evolved, given the widespread access to COVID-19 testing and the roll-out of vaccination and booster programs. By October 2021, near-normal life and service delivery was resuming, despite substantial ongoing cases of COVID-19 infection. However, transplant recipients remained at heightened risk of COVID-19 infection despite vaccination, given their limited response to mRNA vaccines and booster dosing: further risk-reduction strategies required exploration. This article provides a contemporaneous account of these different phases of the pandemic from the transplant clinician’s perspective, and provides constructive suggestions for clinical practice and research.
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Affiliation(s)
- Vassilios Papalois
- Renal and Transplant Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Vassilios Papalois,
| | - Camille N. Kotton
- Infectious Diseases Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Torre-Cisneros
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Davide Croce
- Research Centre in Health Economics and Healthcare Management, Carlo Cattaneo University, Castellanza, Italy
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stéphane Roze
- Vyoo Agency, Health-Economics Department, Villeurbanne, France
| | - Paolo Grossi
- Department of Infectious Diseases, University of Insubria, Varese, Italy
- Infectious and Tropical Diseases Unit, ASST-Sette Laghi, Varese, Italy
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