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1
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Comins-Boo A, Irure-Ventura J, Valentin MO, Belmar-Vega L, López Del Moral Cuesta C, Valero San Cecilio R, Rodrigo Calabia E, Renuncio-García M, Castro Hernández C, Mikhalkovich D, Mota Pérez N, Ruiz San Millán JC, López-Hoyos M, San Segundo D. Low-risk delisting strategy in highly sensitized patients without donor offers included in exchange donation programs. One single-center experience. Hum Immunol 2024; 85:110806. [PMID: 38664156 DOI: 10.1016/j.humimm.2024.110806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/04/2024]
Abstract
Donor exchange programs were designed to allocate organs for highly sensitized (HS) patients. The allocation algorithm differs slightly among countries and includes different strategies to improve access to transplants in HS patients. However, many HS patients with a calculated panel reactive of antibodies (cPRA) of 100 % remain on the waiting list for a long time. Some allocation algorithms assume immunological risk, including Imlifidase treatment, to increase the chance of transplantation in very HS patients. Here, we describe our unicenter experience of low-risk delisting strategy in 15 HS patients included in the Spanish donor exchange program without donor offers. After delisting, 7 out of 15 HS patients reduced the cPRA below 99.95 % and impacted the reduction of time on the waiting list (p = 0.01), where 5 out of 7 achieved transplantation. Within those HS that remained above 99.95 %, 1 out of 8 was transplanted. All the HS were transplanted with delisted DSA, and only one with DSA level rebounded early after transplantation. All HS transplanted after delisting maintain graft function. The transplant immunology laboratories are challenged to search intermediate risk assessment methods for delisting high HS patients.
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Affiliation(s)
- Alejandra Comins-Boo
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Juan Irure-Ventura
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Maria O Valentin
- Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Lara Belmar-Vega
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Covadonga López Del Moral Cuesta
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Rosalía Valero San Cecilio
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Emilio Rodrigo Calabia
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Mónica Renuncio-García
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Carolina Castro Hernández
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Dzmitry Mikhalkovich
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Nerea Mota Pérez
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain
| | - Juan Carlos Ruiz San Millán
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Department of Nephrology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | - Marcos López-Hoyos
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain; Molecular Biology Department, Universidad de Cantabria, Santander, Spain
| | - David San Segundo
- Department of Clinical Immunology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011 Santander, Spain.
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2
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Khomane P, Meshram HS, Banerjee S, Tambi P, Patel H, Patel A, Makwana MJ, Sharma S, Mishra V, Kute VB. COVID-19 Vaccination in Solid-Organ Transplant: A Real-World Multicenter Experience. EXP CLIN TRANSPLANT 2022; 20:805-810. [PMID: 36169102 DOI: 10.6002/ect.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES India ranks third globally in organ procurement and transplant and has the second highest COVID-19 incidence rate, but data regarding COVID-19 vaccination in solid-organ transplant patients are scarce. MATERIALS AND METHODS We created a cross-sectional, anonymous, online questionnaire and sentinvitations to several transplant centers in India. We surveyed vaccine mandates, immunization coverage and side effects, administration timing, infection severity among solid-organ transplant recipients, and booster dosage recommendations. RESULTS The survey results showedthat vaccinepolicy is heterogeneous among centers; vaccination is voluntary at some centers (44.7%), but some centers have established COVID-19 vaccination as a requirement for transplant candidates (44.6%). CoviShield was the most common vaccine administered (89.3%), and more than 50% of transplant recipients and donors were fully vaccinated. Survey results showed that the pretransplant wait time after full vaccination (both doses) is 2 to 4 weeks (48.9%), and the optimal time for vaccination after transplant is 3 to 6 months (59.3%). For vaccinated transplant patients, 89.4% of respondents reported an incidence rate for posttransplant breakthrough infection of less than 25%. For unvaccinated patients, 38.3% ofrespondents reported a 25% to 50% incidence rate of posttransplant COVID- 19 infection. Booster doses are recommended at many transplant centers in India, as reported by 89.4% of survey respondents. CONCLUSIONS The results of the survey suggested that there are no substantial safety concerns Future targets should include increasing efficacy and increasing booster doses of the COVID-19 vaccine.
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Affiliation(s)
- Pritam Khomane
- From the Department of Nephrology, Institute of Kidney Disease and Research Center, Institute of Transplantation Sciences, Ahmedabad, India
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Nimmo A, Gardiner D, Ushiro-Lumb I, Ravanan R, Forsythe JLR. The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic. Transplantation 2022; 106:1312-1329. [PMID: 35404911 PMCID: PMC9213067 DOI: 10.1097/tp.0000000000004151] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%-25% to 8%-10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.
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Affiliation(s)
- Ailish Nimmo
- Renal Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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4
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Caliskan Y, Axelrod D, Guenette A, Lam NN, Kute V, Alhamad T, Schnitzler MA, Lentine KL. COVID-19 vaccination timing and kidney transplant waitlist management: An international perspective. Transpl Infect Dis 2022; 24:e13763. [PMID: 34796585 PMCID: PMC8646503 DOI: 10.1111/tid.13763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for solid organ transplant programs worldwide. The aim of this study is to assess an international perspective on challenges faced by kidney transplant programs. METHODS We administered an electronic survey instrument from January 3, 2021 to June 8, 2021 to staff at transplant programs outside the United States that comprised of 10 questions addressing the management of kidney transplant candidates with asymptomatic COVID-19 infection or unvaccinated who receive an organ offer. RESULTS Respondents (n = 62) represented 19 countries in five continents. Overall, 90.3% of respondents encourage vaccination on the waiting list and prior to planned living donor transplant. Twelve percent of respondents reported that they have decided to inactivate unsensitized candidates (calculated panel reactive antibody, cPRA <80%) until they received the two doses of vaccination, and 7% report inactivating candidates who have received their first vaccine dose pending receipt of their second dose. The majority (88.5%) of international respondents declined organs for asymptomatic, nucleic acid testing (NAT)+ patients during admission without documented prior infection. However, 22.9% of international respondents proceeded with kidney transplant in NAT+ patients who were at least 30 days from initial diagnosis with negative chest imaging. CONCLUSIONS Practitioners in some countries are less willing to accept deceased donor organs for waitlist candidates with incomplete COVID-19 vaccination status and to wait longer before scheduling living donor transplant, compared to United States practices. Access to vaccinations and other resources may contribute to these differences. More research is needed to guide the optimal approach to vaccination before and after transplant.
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Affiliation(s)
- Yasar Caliskan
- Saint Louis University Center for Abdominal TransplantationSt. LouisMissouriUSA
| | - David Axelrod
- University of Iowa/Transplant InstituteIowa CityIowaUSA
| | - Alexis Guenette
- Saint Louis University Center for Abdominal TransplantationSt. LouisMissouriUSA
| | - Ngan N. Lam
- Division of NephrologyCumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Vivek Kute
- SciencesInstitute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of TransplantationAhmedabadIndia
| | - Tarek Alhamad
- Washington University in St. LouisSt. LouisMissouriUSA
| | - Mark A. Schnitzler
- Saint Louis University Center for Abdominal TransplantationSt. LouisMissouriUSA
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal TransplantationSt. LouisMissouriUSA
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5
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Mohan S, King KL, Husain SA, Schold JD. COVID-19-Associated Mortality among Kidney Transplant Recipients and Candidates in the United States. Clin J Am Soc Nephrol 2021; 16:1695-1703. [PMID: 34588178 PMCID: PMC8729425 DOI: 10.2215/cjn.02690221] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on transplantation activity in the United States and globally. Several single-center reports suggest higher morbidity and mortality among candidates waitlisted for a kidney transplant and recipients of a kidney transplant. We aim to describe 2020 mortality patterns during the COVID-19 pandemic in the United States among kidney transplant candidates and recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using national registry data for waitlisted candidates and kidney transplant recipients collected through April 23, 2021, we report demographic and clinical factors associated with COVID-19-related mortality in 2020, other deaths in 2020, and deaths in 2019 among waitlisted candidates and transplant recipients. We quantify excess all-cause deaths among candidate and recipient populations in 2020 and deaths directly attributed to COVID-19 in relation to prepandemic mortality patterns in 2019 and 2018. RESULTS Among deaths of patients who were waitlisted in 2020, 11% were attributed to COVID-19, and these candidates were more likely to be male, obese, and belong to a racial/ethnic minority group. Nearly one in six deaths (16%) among active transplant recipients in the United States in 2020 was attributed to COVID-19. Recipients who died of COVID-19 were younger, more likely to be obese, had lower educational attainment, and were more likely to belong to racial/ethnic minority groups than those who died of other causes in 2020 or 2019. We found higher overall mortality in 2020 among waitlisted candidates (24%) than among kidney transplant recipients (20%) compared with 2019. CONCLUSIONS Our analysis demonstrates higher rates of mortality associated with COVID-19 among waitlisted candidates and kidney transplant recipients in the United States in 2020.
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Affiliation(s)
- Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia University Renal Epidemiology Group, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Kristen L. King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia University Renal Epidemiology Group, New York, New York
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia University Renal Epidemiology Group, New York, New York
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Center for Populations Health Research, Cleveland Clinic, Cleveland, Ohio
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6
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Joean O, Welte T, Gottlieb J. Chest Infections after Lung Transplantation. Chest 2021; 161:937-948. [PMID: 34673023 DOI: 10.1016/j.chest.2021.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Despite substantial progress in the long-term follow-up strategies for lung transplant recipients, morbidity and mortality remain high mostly due to the elevated infectious risk and to the development of chronic lung allograft dysfunction. The high immunosuppressive levels necessary to prevent acute rejection and the graft's constant exposure to the environment come at the high price of frequent infectious complications. Moreover, some infectious agents have been shown to trigger acute rejection or chronic allograft dysfunction. A rapid diagnostic approach followed by an early treatment and follow-up strategy are of paramount importance. They are, however, challenging endeavors due to the vast spectrum of possible pathogens and to the discrete clinical features as a consequence of transplant recipients' impaired immune response. This review proposes a stratified diagnostic strategy, discusses the most relevant pathogens and the corresponding therapeutic approaches while also offering an insight in the infection prevention strategies: vaccination, prophylaxis, preemptive therapy, antibiotic stewardship.
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Affiliation(s)
- Oana Joean
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany.
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic is a major challenge to global health, particularly among vulnerable populations. Here, we describe the emerging epidemiology and relevant data on treatment options for COVID-19. We discuss the implications of current knowledge for solid organ transplant (SOT) recipients. RECENT FINDINGS Risk factors and outcomes of COVID-19 among SOT recipients remain uncertain, but recent data suggest similar outcomes to the general population. Case reports of donor-derived SARS-CoV-2 infection are emerging. Few studies on treatment of COVID-19 among SOT recipients are available, and therefore, general recommendations are similar to the general population. Vaccine efficacy in the SOT population is uncertain. SUMMARY COVID-19 remains a significant threat to SOT recipients and studies on treatment and prevention specific to this population are urgently needed. Although vaccines represent the greatest hope to control this pandemic, their efficacy in this immunocompromised population is uncertain.
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Affiliation(s)
- Justin C. Laracy
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, NY
| | - Benjamin A. Miko
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, NY
| | - Marcus R. Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, NY
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8
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Craig-Schapiro R, Salinas T, Lubetzky M, Abel BT, Sultan S, Lee JR, Kapur S, Aull MJ, Dadhania DM. COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients. Am J Transplant 2021; 21:1576-1585. [PMID: 33043597 PMCID: PMC7675359 DOI: 10.1111/ajt.16351] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has brought unprecedented challenges to the transplant community. The reduction in transplantation volume during this time is partly due to concerns over potentially increased susceptibility and worsened outcomes of COVID-19 in immunosuppressed recipients. The consequences of COVID-19 on patients waitlisted for kidney transplantation, however, have not previously been characterized. We studied 56 waitlisted patients and 80 kidney transplant recipients diagnosed with COVID-19 between March 13 and May 20, 2020. Despite similar demographics and burden of comorbidities between waitlisted and transplant patients, waitlisted patients were more likely to require hospitalization (82% vs. 65%, P = .03) and were at a higher risk of mortality (34% vs. 16%, P = .02). Intubation was required in one third of hospitalized patients in each group, and portended a very poor prognosis. The vast majority of patients who died were male (84% waitlist, 100% transplant). Multivariate analysis demonstrated waitlist status, age, and male sex were independently associated with mortality. COVID-19 has had a dramatic impact on waitlisted patients, decreasing their opportunities for transplantation and posing significant mortality risk. Understanding the impact of COVID-19 on waitlist patients in comparison to transplant recipients may aid centers in weighing the risks and benefits of transplantation in the setting of ongoing COVID-19.
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Affiliation(s)
| | - Thalia Salinas
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY
| | - Michelle Lubetzky
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY
- Department of Transplantation Medicine, Weill Cornell Medicine, New York, NY
| | - Brittany T. Abel
- Division of Transplant Surgery, Weill Cornell Medicine, New York, NY
| | - Samuel Sultan
- Division of Transplant Surgery, Weill Cornell Medicine, New York, NY
| | - John R. Lee
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY
- Department of Transplantation Medicine, Weill Cornell Medicine, New York, NY
| | - Sandip Kapur
- Division of Transplant Surgery, Weill Cornell Medicine, New York, NY
| | - Meredith J. Aull
- Division of Transplant Surgery, Weill Cornell Medicine, New York, NY
- Department of Transplantation Medicine, Weill Cornell Medicine, New York, NY
| | - Darshana M. Dadhania
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY
- Department of Transplantation Medicine, Weill Cornell Medicine, New York, NY
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9
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Bentata Y. Organ Shortage: Major or Minor Impact of the COVID-19 Pandemic? EXP CLIN TRANSPLANT 2021; 19:624-626. [PMID: 33605197 DOI: 10.6002/ect.2020.0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yassamine Bentata
- From the Nephrology Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, University Mohammed First.,the Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed First, Oujda, Morocco
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10
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Impact of the COVID-19 pandemic on the nephrology activity of hemodialysis started in an emergency context: a view from Morocco. J Nephrol 2021; 34:15-17. [PMID: 33387339 PMCID: PMC7776299 DOI: 10.1007/s40620-020-00947-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022]
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Klassen D. New Answers to Old Questions: Waitlist Versus Transplant Outcomes in the Coronavirus Disease 2019 Era. Kidney Int Rep 2020; 6:3-4. [PMID: 33251386 PMCID: PMC7685133 DOI: 10.1016/j.ekir.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- David Klassen
- United Network for Organ Sharing, Richmond, Virginia, USA
- Correspondence: David Klassen, Office of the Chief Medical Officer, United Network for Organ Sharing, 700 North 4th Street, Richmond, Virginia 23219, USA.
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Watschinger B, Watschinger C, Reindl-Schwaighofer R, Meyer EL, Deak AT, Hammer T, Eigner M, Sprenger-Mähr H, Schneeberger S, Cejka D, Mayer G, Oberbauer R, Rosenkranz AR, Kerschbaum J. Impact of Timely Public Health Measures on Kidney Transplantation in Austria during the SARS-CoV-2 Outbreak-A Nationwide Analysis. J Clin Med 2020; 9:jcm9113465. [PMID: 33126481 PMCID: PMC7693584 DOI: 10.3390/jcm9113465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 led to considerable morbidity/mortality worldwide and tremendously impacted on daily life. Strict lockdown measures were implemented early to contain the viral outbreak in Austria. Massive changes in organizational structures of healthcare facilities followed with unclear implications on the care of non-COVID-19-affected patients. We studied the nationwide impact of COVID-19 on kidney transplantation in Austria during the first six months of 2020. Concurrent with general lockdown measures, all kidney transplant activity was suspended from 13 March to 9 April. Nevertheless, between January and June, total transplant (p = 0.48) and procured donor organ numbers (p = 0.6) did not differ significantly from earlier years. Ten (0.18%) of 5512 prevalent Austrian kidney transplant recipients were diagnosed with SARS-CoV-2. The case fatality rate (one death; 10%) in renal transplant patients was less than in other countries but higher than in Austria's general population (2.4%). We conclude that early and strict general lockdown measures imposed by the government allowed an early, however cautious, re-opening of Austrian transplant programs and played a crucial role for the favorable outcomes of SARS-CoV-2 in Austrian kidney transplant patients. Even though it may be uncertain whether similar results may be obtainable in other countries, the findings may support early intervention strategies during similar episodes in the future.
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Affiliation(s)
- Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, 1090 Vienna, Austria; (C.W.); (R.R.-S.); (R.O.)
- Correspondence: ; Tel.: +43-1-40400-43910
| | - Clara Watschinger
- Department of Nephrology, Medical University of Vienna, 1090 Vienna, Austria; (C.W.); (R.R.-S.); (R.O.)
| | - Roman Reindl-Schwaighofer
- Department of Nephrology, Medical University of Vienna, 1090 Vienna, Austria; (C.W.); (R.R.-S.); (R.O.)
| | - Elias L. Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria;
| | - Andras T. Deak
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.T.D.); (A.R.R.)
| | - Tamara Hammer
- Department of Medicine III: Nephrology, Transplantation Medicine, Rheumatology, Geriatrics, Ordensklinikum Linz Elisabethinen, 4010 Linz, Austria; (T.H.); (D.C.)
| | - Manfred Eigner
- Department of Medicine I, Klinik Favoriten, 1100 Vienna, Austria;
| | - Hannelore Sprenger-Mähr
- Landeskrankenhaus Feldkirch Abteilung für Innere Medizin III, Nephrologie und Dialyse, 6807 Feldkirch, Austria;
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Daniel Cejka
- Department of Medicine III: Nephrology, Transplantation Medicine, Rheumatology, Geriatrics, Ordensklinikum Linz Elisabethinen, 4010 Linz, Austria; (T.H.); (D.C.)
| | - Gert Mayer
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, 6020 Innsbruck, Austria; (G.M.); (J.K.)
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, 1090 Vienna, Austria; (C.W.); (R.R.-S.); (R.O.)
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.T.D.); (A.R.R.)
| | - Julia Kerschbaum
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, 6020 Innsbruck, Austria; (G.M.); (J.K.)
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, 6020 Innsbruck, Austria
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13
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Gopal JP, Papalois VE. COVID-19 pandemic: Building organisational flexibility to scale transplant programs. World J Transplant 2020; 10:277-282. [PMID: 33134115 PMCID: PMC7579434 DOI: 10.5500/wjt.v10.i10.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner. The pandemic has had a significant impact on transplantation worldwide. The logistics of travel restrictions, stretching of available resources, unclear risk of infection in immunosuppressed transplant recipients, and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant activity. We must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our patients. Building a culture of honesty and transparency (with patients, families, colleagues, societies, and authorities), keeping the channels of communication open, working in collaboration with others (at local, regional, national, and international levels), and not restarting without rethinking and appraising all elements of our practice, are the main underlying principles to increase the flexibility.
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Affiliation(s)
- Jeevan Prakash Gopal
- Imperial College Renal and Transplant Center, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
| | - Vassilios E Papalois
- Imperial College Renal and Transplant Center, Department of Surgery and Cancer, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
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14
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Kates OS, Haydel BM, Florman SS, Rana MM, Chaudhry ZS, Ramesh MS, Safa K, Kotton CN, Blumberg EA, Besharatian BD, Tanna SD, Ison MG, Malinis M, Azar MM, Rakita RM, Morillas JA, Majeed A, Sait AS, Spaggiari M, Hemmige V, Mehta SA, Neumann H, Badami A, Goldman JD, Lala A, Hemmersbach-Miller M, McCort ME, Bajrovic V, Ortiz-Bautista C, Friedman-Moraco R, Sehgal S, Lease ED, Fisher CE, Limaye AP. COVID-19 in solid organ transplant: A multi-center cohort study. Clin Infect Dis 2020; 73:e4090-e4099. [PMID: 32766815 PMCID: PMC7454362 DOI: 10.1093/cid/ciaa1097] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well-described. Methods We performed a multi-center cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (IQR 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [aOR 3.0, 95%CI 1.7-5.5, p<0.001], congestive heart failure [aOR 3.2, 95%CI 1.4-7.0, p=0.004], chronic lung disease [aOR 2.5, 95%CI 1.2-5.2, p=0.018], obesity [aOR 1.9, 95% CI 1.0-3.4, p=0.039]) and presenting findings (lymphopenia [aOR 1.9, 95%CI 1.1-3.5, p=0.033], abnormal chest imaging [aOR 2.9, 95%CI 1.1-7.5, p=0.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
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Affiliation(s)
- Olivia S Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brandy M Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander S Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi M Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zohra S Chaudhry
- Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Mayur S Ramesh
- Transplantation Infectious Diseases and Inmunotherapy, Henry Ford Health System, Detroit, MI, USA
| | - Kassem Safa
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emily A Blumberg
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Behdad D Besharatian
- Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Sajal D Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale-New School of Medicine, New Haven, CT, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale-New School of Medicine, New Haven, CT, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Jose A Morillas
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Aneela Majeed
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Afrah S Sait
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mario Spaggiari
- Division of Transplantation, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Abbasali Badami
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jason D Goldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Anuradha Lala
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Valida Bajrovic
- Division of Infectious Disease, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Rachel Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Sameep Sehgal
- Department of Thoracic Medicine And Surgery, Temple University, Philadelphia, PA, USA
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Cynthia E Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
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