COVID-19 in solid organ transplant recipients: A single-center case series from Spain

Am J Transplant. 2020 Jul;20(7):1849-1858 doi: 10.1111/ajt.15929.
Abstract

The clinical characteristics, management, and outcome of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after solid organ transplant (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%], and heart [22.2%]) recipients diagnosed with COVID-19 by March 23, 2020 at a tertiary-care center at Madrid. Median age at diagnosis was 71.0 ± 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine) was used in 50.0% of patients and had to be prematurely discontinued in 2 of them. Other antiviral regimens included hydroxychloroquine monotherapy (27.8%) and interferon-β (16.7%). As of April 4, the case-fatality rate was 27.8% (5/18). After a median follow-up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C-reactive protein levels at various points were significantly higher among recipients who experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS-CoV-2 infection has a severe course in SOT recipients.

Metadata
Publication type: Observational Study
Organ: Kidney; Liver; Heart
Language: English
Country: Spain
MeSH terms: Aged; Antiviral Agents; Betacoronavirus; COVID-19; Coronavirus Infections; Drug Combinations; Female; Fever; Humans; Hydroxychloroquine; Immunosuppressive Agents; Interferon-beta; Lopinavir; Male; Middle Aged; Organ Transplantation; Pandemics; Pneumonia, Viral; Radiography, Thoracic; Retrospective Studies; Ritonavir; SARS-CoV-2; Spain; Transplant Recipients; Kidney Transplantation; Liver Transplantation; Heart Transplantation; Interferon-Beta; 0 (Antiviral Agents); 0 (Drug Combinations); 0 (Immunosuppressive Agents); 0 (Lopinavir-Ritonavir Drug Combination); 2494G1JF75 (Lopinavir); 4QWG6N8QKH (Hydroxychloroquine); 77238-31-4 (Interferon-Beta); O3J8G9O825 (Ritonavir); Covid-19