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Xu L, Chen X, Yang X, Chen S, Yang M, Yuan Z, Chen R, Wang J, Jiang H, Xu J, Wang Y. Clinical features and outcomes in kidney transplant recipients with COVID-19 pneumonia: a single center retrospective cohort study. Front Cell Infect Microbiol 2024; 14:1392491. [PMID: 39211792 PMCID: PMC11358093 DOI: 10.3389/fcimb.2024.1392491] [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: 05/10/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This retrospective cohort study aimed to assess the clinical features, treatment outcomes, and short-term prognosis in kidney transplant recipients (KTRs) with concurrent coronavirus disease 2019 (COVID-19) pneumonia. Methods KTRs with COVID-19 pneumonia who were admitted to our hospital from December 28, 2022, to March 28, 2023 were included in the study. Their clinical symptoms, responses to antiviral medications, and short-term prognosis were analyzed. Results A total of 64 KTRs with initial diagnosis of COVID-19 pneumonia were included in this study. The primary symptoms were fever, cough, and myalgia, with an incidence of 79.7%, 89.1%, and 46.9%, respectively. The administration of antiviral drugs (paxlovid or molnupiravir) within 1-5 days and for over 5 days demonstrated a statistically significant reduction in viral shedding time compared to the group without antiviral medication (P=0.002). Both the paxlovid and molnupiravir treatment groups exhibited a significantly shorter duration of viral shedding time in comparison to the group without antiviral drugs (P=0.002). After 6 months of recovery, there was no significantly negative impact on transplant kidney function (P=0.294). Conclusion Fever, cough, and myalgia remain common initial symptoms of concurrent COVID-19 pneumonia in KTRs. Early use of antiviral drugs (paxlovid or molnupiravir) is associated with better therapeutic outcomes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a limited impact on the short-term renal function of the KTRs with concurrent moderate or severe COVID-19 pneumonia.
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Affiliation(s)
- Liang Xu
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiuxiu Chen
- Department of Breast and Thyroid Surgery, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xuying Yang
- Department of Scientific Affaires, Hugobiotech Co., Ltd., Beijing, China
| | - Song Chen
- Department of Nephrology, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Meng Yang
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zehua Yuan
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rentian Chen
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jianli Wang
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
- Organ Transplant Center, Tianjin First Central Hospital, Tianjin, China
| | - Hongtao Jiang
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jian Xu
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yi Wang
- Department of Organ Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
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Arumugam S, Vadivel K, Dhaked DK, Prasanna VS, Yellurkar ML, Das P, Manoharan R, Thomas AJ, Singh L, Singh S, Velayutham R. Antiviral Activity of Cinchona officinalis, a Homeopathic Medicine, against COVID-19. HOMEOPATHY 2024; 113:16-24. [PMID: 37673083 DOI: 10.1055/s-0043-1770339] [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: 09/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a potentially fatal disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several studies have shown that hydroxychloroquine (HCQ) significantly inhibits SARS-CoV-2 infections in vitro. OBJECTIVE Since the phytoconstituents of Cinchona officinalis (CO) are similar to those of HCQ, the objective of this study was to test the antiviral potential of different homeopathic formulations of CO. METHODS An analysis of the molecular composition of CO was carried out using ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry, followed by a detailed docking study. The constituents of CO were docked against various targets of SARS-CoV-2, and the binding potential of the phytoconstituents was compared and quantified. The ligand with the lowest Glide docking score is considered to have the best binding affinity. The cytotoxicity of several homeopathic formulations, including CO mother tincture (CO-MT), was also checked on VeroE6 cells. A known antiviral, remdesivir, was used as a positive control for the in vitro assays to evaluate the effects of CO-MT against SARS-CoV-2-infected VeroE6 cells. RESULTS Molecular docking studies showed that constituents of CO exhibited binding potential to various targets of SARS-CoV-2, including Mpro, PLpro, RdRp, nucleocapsid protein, ACE2 (in host) and spike protein. Quinoline, one of the constituents of CO, can potentially bind the spike protein of SARS-CoV-2. Quinic acid showed better binding capabilities with Mpro, PLpro RdRp, nucleocapsid protein and ACE2 (allosteric site) than other constituents. Quinidine exhibited better binding to ACE2. Compared to HCQ, other phytoconstituents of CO had the equivalent potential to bind the RNA-dependent RNA polymerase, nucleocapsid protein, Mpro, PLpro and spike protein of SARS-CoV-2. In vitro assays showed that homeopathic CO-MT was not cytotoxic and that CO-MT and remdesivir respectively caused 89% and 99% inhibition of SARS-CoV-2 infection in VeroE6 cells. CONCLUSION Based on this in silico and in vitro evidence, we propose CO-MT as a promising antiviral medicine candidate for treating COVID-19. In vivo investigation is required to clarify the therapeutic potential of CO-MT in COVID-19.
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Affiliation(s)
- Somasundaram Arumugam
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, Kolkata, West Bengal, India
| | - Kumaravel Vadivel
- Department of Pathology and Microbiology, National Institute of Homeopathy (NIH), Kolkata, West Bengal, India
| | - Devendra Kumar Dhaked
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, Kolkata, West Bengal, India
| | - Vani Sai Prasanna
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, Kolkata, West Bengal, India
| | - Manoj Limbraj Yellurkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, Kolkata, West Bengal, India
| | - Pamelika Das
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, Kolkata, West Bengal, India
| | - Raja Manoharan
- Department of Homeopathic Pharmacy, National Institute of Homeopathy (NIH), Kolkata, West Bengal, India
| | | | - Lalith Singh
- National Institute of Homeopathy (NIH), Kolkata, West Bengal, India
| | - Subhas Singh
- Department of Organon of Medicine, National Institute of Homeopathy (NIH), Kolkata, West Bengal, India
| | - Ravichandiran Velayutham
- National Institute of Pharmaceutical Education and Research (NIPER), Chunilal Bhawan, 168 Maniktala Main Road, Kolkata, West Bengal, India
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ElNahid MS, Issac MSM, Sadek KM. Outcome of COVID-19 in Egyptian living-donor kidney transplant recipients and relation to maintenance immunosuppressive drugs: a pilot study. Sci Rep 2023; 13:19002. [PMID: 37923735 PMCID: PMC10624883 DOI: 10.1038/s41598-023-45750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) in kidney transplant recipients is a subject of much debate and became of interest to nephrologists amidst the pandemic. The main concerns are the influence of the chronic use of immunosuppressive drugs, the viral-related risk of acute rejection, and the long-term outcome of allograft function. This single-center prospective study included kidney transplant recipients with COVID-19 infection. Patients were maintained on immunosuppressive regimens. The severity of disease was defined as oxygen saturation < 94%, the need for hospitalization and/or hemodialysis, the occurrence of acute kidney injury (AKI), and mortality. Seventeen patients (54.8%) required hospital admission, four patients needed hemodialysis (12.9%), twelve patients (38.7%) had AKI, and three patients died (9.7%). Oxygen saturation < 94% showed a positive correlation with the presence of diabetes (p value 0.031) and a negative correlation with the maintenance steroid dose (p value 0.046). A negative correlation existed between the need for hemodialysis and average Cyclosporin level (p value 0.019) and between the need for hospitalization and average Tacrolimus level (p value 0.046). Severity of disease was associated with the presence of lymphopenia (p value 0.042), the cumulative steroid dose (p value 0.001), increased serum levels of LDH (p value 0.010), Ferritin (p value 0.020), AST (p value 0.047), and ALT (p value 0.006) and D-dimer levels more than 0.5 mg/L (p value 0.038). This study highlighted that the immunocompromised state of renal transplant recipients may not be regarded as a disadvantage in the setting of COVID-19 infection. Studies on a larger scale are needed to validate these results.
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Affiliation(s)
- Maggie Said ElNahid
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Khaled Marzouk Sadek
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Shumakov DV, Zybin DI, Zulkarnaev AB, Dontsov VV, Agafonov EG, Popov MA. Transplantation of solid organs during the pandemic of a new coronavirus infection. TRANSPLANTOLOGIYA. THE RUSSIAN JOURNAL OF TRANSPLANTATION 2023; 15:376-389. [DOI: 10.23873/2074-0506-2023-15-3-376-389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The end-stage stage of chronic diseases of solid organs is rather significant in the structure of morbidity and mortality among patients worldwide. To date, there are more than six million patients in this status worldwide. Heart, liver and kidney transplantation is the gold standard of treatment for these patients. The number of transplants is growing every year.At the end of 2019, the world faced a new type of viral infection – SARS-CoV-2 – a highly contagious systemic respiratory disease transmitted by airborne droplets, which in three months led to a pandemic and killed hundreds of thousands of people. The pandemic has made adjustments to the structure of planned medical care. The number of planned operations has decreased significantly, and the number of the infection-associated complications has increased.Patients with end-stage chronic diseases initially have weakened immunity and represent the category most susceptible to the infection. At the moment, the question of patient management tactics remains open. There is no consensus on the patient management tactics before surgery and in the posttransplantation period for patients at the end-stage chronic disease of different organs. This topic requires further study and the development of treatment algorithms for such patients.
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Affiliation(s)
- D. V. Shumakov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - D. I. Zybin
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - A. B. Zulkarnaev
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - V. V. Dontsov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - E. G. Agafonov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - M. A. Popov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
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Anand A, Aoyagi H. Understudied Hyperphosphatemia (Chronic Kidney Disease) Treatment Targets and New Biological Approaches. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:959. [PMID: 37241191 PMCID: PMC10221414 DOI: 10.3390/medicina59050959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Hyperphosphatemia is a secondary disorder of chronic kidney disease that causes vascular calcifications and bone-mineral disorders. As per the US Centers for Disease Control and Prevention, renal damage requires first-priority medical attention for patients with COVID-19; according to a Johns Hopkins Medicine report, SARS-CoV-2 can cause renal damage. Therefore, addressing the research inputs required to manage hyperphosphatemia is currently in great demand. This review highlights research inputs, such as defects in the diagnosis of hyperphosphatemia, flaws in understanding the mechanisms associated with understudied tertiary toxicities, less cited adverse effects of phosphate binders that question their use in the market, socioeconomic challenges of renal treatment and public awareness regarding the management of a phosphate-controlled diet, novel biological approaches (synbiotics) to prevent hyperphosphatemia as safer strategies with potential additional health benefits, and future functional food formulations to enhance the quality of life. We have not only introduced our contributions to emphasise the hidden aspects and research gaps in comprehending hyperphosphatemia but also suggested new research areas to strengthen approaches to prevent hyperphosphatemia in the near future.
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Affiliation(s)
- Ajeeta Anand
- Institute of Life Sciences and Bioengineering, Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba 305-8572, Japan
| | - Hideki Aoyagi
- Institute of Life Sciences and Bioengineering, Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba 305-8572, Japan
- Institute of Life and Environmental Sciences, University of Tsukuba, Tsukuba 305-8572, Japan
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Darılmaz Yüce G, Ulubay G, Tek K, Savaş Bozbaş Ş, Erol Ç, Büyükaşık P, Haberal KM, Arslan AH, Akçay MŞ, Haberal M. Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience. EXP CLIN TRANSPLANT 2023; 21:451-459. [PMID: 34635037 DOI: 10.6002/ect.2021.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. MATERIALS AND METHODS Our study included 23 solidorgan transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P <.05 was considered statistically significant. RESULTS Mean age of solid-organ transplant recipients was 49.8 ± 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P = .224). Transplant recipients had greater requirements for nasal oxygen (P = .005) and noninvasive mechanical ventilation (P = .003) and had longer length of intensive care unit stay (P = .030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P = .439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P <.05). Secondary infections were major causes of mortality in transplant recipients. CONCLUSIONS COVID-19 infection resulted in higher mortality in solid-organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.
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Affiliation(s)
- Gülbahar Darılmaz Yüce
- From the Department of Pulmonary Diseases Başkent University Faculty of Medicine, Ankara, Turkey
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Behura A, Naik L, Patel S, Das M, Kumar A, Mishra A, Nayak DK, Manna D, Mishra A, Dhiman R. Involvement of epigenetics in affecting host immunity during SARS-CoV-2 infection. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166634. [PMID: 36577469 PMCID: PMC9790847 DOI: 10.1016/j.bbadis.2022.166634] [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] [Received: 06/28/2022] [Revised: 10/26/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
Coronavirus disease 19 (COVID-19) is caused by a highly contagious RNA virus Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2), originated in December 2019 in Wuhan, China. Since then, it has become a global public health concern and leads the disease table with the highest mortality rate, highlighting the necessity for a thorough understanding of its biological properties. The intricate interaction between the virus and the host immune system gives rise to diverse implications of COVID-19. RNA viruses are known to hijack the host epigenetic mechanisms of immune cells to regulate antiviral defence. Epigenetics involves processes that alter gene expression without changing the DNA sequence, leading to heritable phenotypic changes. The epigenetic landscape consists of reversible modifications like chromatin remodelling, DNA/RNA methylation, and histone methylation/acetylation that regulates gene expression. The epigenetic machinery contributes to many aspects of SARS-CoV-2 pathogenesis, like global DNA methylation and receptor angiotensin-converting enzyme 2 (ACE2) methylation determines the viral entry inside the host, viral replication, and infection efficiency. Further, it is also reported to epigenetically regulate the expression of different host cytokines affecting antiviral response. The viral proteins of SARS-CoV-2 interact with various host epigenetic enzymes like histone deacetylases (HDACs) and bromodomain-containing proteins to antagonize cellular signalling. The central role of epigenetic factors in SARS-CoV-2 pathogenesis is now exploited as promising biomarkers and therapeutic targets against COVID-19. This review article highlights the ability of SARS-CoV-2 in regulating the host epigenetic landscape during infection leading to immune evasion. It also discusses the ongoing therapeutic approaches to curtail and control the viral outbreak.
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Affiliation(s)
- Assirbad Behura
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Lincoln Naik
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Salina Patel
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Mousumi Das
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Ashish Kumar
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Abtar Mishra
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Dev Kiran Nayak
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Debraj Manna
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India
| | - Amit Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology Jodhpur, Rajasthan 342011, India
| | - Rohan Dhiman
- Laboratory of Mycobacterial Immunology, Department of Life Science, National Institute of Technology, Rourkela 769008, Odisha, India.
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Rawashdeh B, AlRyalat SA, Abuassi M, Syaj S, Jeyyab MA, Pearson T, Kim J. Impact of COVID-19 on abdominal organ transplantation: A bibliometric analysis. Transpl Infect Dis 2023:e14027. [PMID: 36762493 DOI: 10.1111/tid.14027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Abdominal solid organ transplant (SOT) programs have been hit hard by the COVID-19 pandemic, which was officially declared as such on March 11, 2020. Over two years, the tightening and softening of limitations in response to the "waves" of infection and COVID-19 fluctuations have provided distinct issues for waitlisted patients, transplant recipients, and transplant organizations. METHOD We searched Scopus using the terms "transplant" and "transplantation," and organ-related phrases like "intestin*," "liver," "kidney," "hepatic," "renal," and "pancrea*," as well as COVID-19 terms such as "COVID-19," "coronavirus," and "SARS-CoV-2." We included articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata and studied nations, institutions, authors, journals, keywords, and articles. VOSviewer 1.6.18 and Excel were used to create tables and figures. RESULTS We included 1,251 of 1,256 studies. Among them, 289 (23.1%), 489 (39.1%), and 473 (37.8%) papers were published in 2020, 2021, and 2022, with mean (SD) citations of 30.3 (53.3), 14.3 (26.8), and 4.79 (6.38), respectively. Compared to other abdominal organs, the field of kidney transplants had the highest number of articles describing the impact of COVID-19. The United States contributed the most articles, and the American Journal of Transplantation published the most articles. CONCLUSION To our knowledge, this is the first bibliometric investigation of the impact of COVID-19 on SOT. This report provides an overview of the research conducted on SOT and COVID-19. There is potential for this bibliometric analysis to serve as a beneficial and practical resource for ongoing and future research.
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Affiliation(s)
- Badi Rawashdeh
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Terra Pearson
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joohyun Kim
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Sosa RA, Mone T, Naini BV, Kohn DB, Reed EF, Wheeler K, Campo-Fernandez B, Davila A, Chaffin DJ, DiNorcia J, Kaldas FM, Cohen A, Lum EL, Veale JL, Kogut NM. Apheresis of Deceased Donors as a New Source of Mobilized Peripheral Blood Hematopoietic Stem Cells for Transplant Tolerance. Transplantation 2023; 107:504-510. [PMID: 35974436 PMCID: PMC9877104 DOI: 10.1097/tp.0000000000004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Solid organ transplantation is the therapy of choice for many patients with end-stage organ failure; however, recipients must remain on lifelong immunosuppression, leaving them susceptible to infections and cancer. The study of transplant tolerance to prolong graft survival in the absence of immunosuppression has been restricted to recipients of living donor allografts; however, deceased donors significantly outnumber living donors. Mobilization of hematopoietic stem cells (HSCs) from the bone marrow to peripheral blood (PB) could allow PB-HSCs to be used to induce tolerance in deceased donor kidney recipients; however, a major concern is the well-known concomitant mobilization of immune cells into the liver. METHODS We mobilized HSCs to the PD using a protocol of 2 doses of granulocyte colony-stimulating factor and 1 dose of plerixafor, followed by the collection of mobilized cells via apheresis in 3 deceased donors. The physiological, laboratory, and radiographic parameters were monitored throughout the procedure. Longitudinal biopsies were performed to assess the potential for ectopic liver mobilization. RESULTS The use of both agents led to the successful mobilization of peripheral blood CD34+ cells, demonstrating the potential for use in transplant tolerance protocols. Increased immune cell trafficking into the liver was not observed, and apheresis of mobilized cells resulted in a uniform decrease in all liver leukocyte subsets. CONCLUSIONS HSCs can be mobilized and collected from the PB of brain-dead donors. This new approach may facilitate the dissemination of immune tolerance trials beyond living-donor kidney transplantation to deceased-donor transplantation, without sacrificing the transplantability of the liver.
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Affiliation(s)
- Rebecca A. Sosa
- Dept of Pathology and Lab Medicine, UCLA, Los Angeles, CA
- UCLA Immunogenetics Center, Los Angeles, CA
| | | | - Bita V. Naini
- Dept of Pathology and Lab Medicine, UCLA, Los Angeles, CA
| | - Donald B. Kohn
- Department of Microbiology, Immunology & Molecular Genetics, UCLA, Los Angeles, CA
- Dept of Pediatrics, Los Angeles, CA
- Dept of Molecular & Medical Pharmacology, Los Angeles, CA
| | - Elaine F. Reed
- Dept of Pathology and Lab Medicine, UCLA, Los Angeles, CA
- UCLA Immunogenetics Center, Los Angeles, CA
| | | | | | - Alejandra Davila
- Department of Microbiology, Immunology & Molecular Genetics, UCLA, Los Angeles, CA
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Jha PK, Shukla S, Bansal D, Bansal SB, Sethi S, Jain M, Yadav DK, Gadde A, Mahapatra AK, Sodhi P, Kher V. COVID-19 in Renal Transplant Recipients - A Single Center Experience from India. Indian J Nephrol 2022; 32:416-422. [PMID: 36568590 PMCID: PMC9775611 DOI: 10.4103/ijn.ijn_479_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 09/12/2021] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The information on the clinical outcome of renal transplant recipients getting COVID-19 infection is sparse. The aim of this study is to report a single-center experience of renal transplant recipients with COVID-19 from India. METHODS This was a retrospective study of 23 consecutive renal transplant recipients with COVID-19 infection presenting to our center from May 2020 to August 2020. Clinical parameters, laboratory values, imaging characteristics, and outcome of the patients were collected and analyzed. RESULTS Median follow-up duration was 36 (range: 10-110) days. Median age of patients was 54 (23-70) years, and 87% were male. Median duration since transplant was 69 (range: 15-132) months. The most common presenting feature was fever (82.6%), followed by breathlessness (43.5%) and cough (30.4%). Hospitalization rate was 52.2%, while 34.8% required ICU care. Severe to critical disease was seen in 39.1% of patients, and 17.4% required mechanical ventilation. Patients with severe disease had a higher incidence of lymphopenia (P = 0.005) when compared to the ones with mild to moderate disease. Acute kidney injury was seen in 39.1% of patients, and 13% required dialysis. Mortality rate was 13% overall, and 25% in those hospitalized. CONCLUSION Renal transplant recipients with COVID-19 have a poor outcome. Although not all of them need hospitalization, they should be monitored closely. Immunosuppression minimization is an important part of the treatment strategy.
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Affiliation(s)
- Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Saurabh Shukla
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Shyam Bihari Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Sidharth Sethi
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Ashwini Gadde
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Amit Kumar Mahapatra
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Puneet Sodhi
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta – The Medicity, Gurugram, Haryana, India
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11
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Solid Organ Rejection following SARS-CoV-2 Vaccination or COVID-19 Infection: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10081289. [PMID: 36016180 PMCID: PMC9412452 DOI: 10.3390/vaccines10081289] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ. Objectives: To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction. Results: One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male (n = 51, 53.1%) and were of White (Caucasian) (n = 51, 53.7%) and Hispanic (n = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech (n = 31), Moderna (n = 14), Oxford Uni-AstraZeneca (n = 10) and Sinovac-CoronaVac (n = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2–17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5–21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success (n = 70, 85.4%), graft failure (n = 12, 14.6%), survived (n = 90, 95.7%) and died (n = 4, 4.3%)]. Conclusion: The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.
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12
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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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13
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Giannis D, Ziogas IA, Esagian SM, Matenoglou E, Moris D. Transplant Immunosuppression Management and COVID-19. EXP CLIN TRANSPLANT 2022; 20:706-707. [PMID: 32967603 DOI: 10.6002/ect.2020.0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Dimitrios Giannis
- From the Institute of Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
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14
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Sigler R, Chen V, Law N. Evolution of Clinical Care in COVID-Infected Solid Organ Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2022; 9:185-198. [PMID: 35669887 PMCID: PMC9154200 DOI: 10.1007/s40472-022-00368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review In this review, we aim to summarize the evolution of care for the solid organ transplant recipient (SOTR) with COVID-19 disease, based on the current published guidelines and our center's experience. Recent Findings Oral antiviral medications and monoclonal antibodies are now used with the goal to prevent severe disease. Immunomodulating drugs in addition to antivirals have been used in the treatment of severe COVID-19. Summary With the ongoing pandemic and unique challenges posed by the SOTR, understanding the risk and advancing management and treatment of COVID-19 infections are imperative to the successful care of a transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel therapeutics towards COVID-19.
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Affiliation(s)
- Rachel Sigler
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9444 Medical Center Drive, MC 0879, La Jolla, CA 92093-0879 USA
| | - Victor Chen
- Department of Pharmacy, University of California San Diego, La Jolla, CA USA
| | - Nancy Law
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9444 Medical Center Drive, MC 0879, La Jolla, CA 92093-0879 USA
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15
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Gupta AK, Leslie A, Hewitt JN, Kovoor JG, Ovenden CD, Edwards S, Chan JCY, Worthington MG. Cardiac surgery on patients with COVID-19: a systematic review and meta-analysis. ANZ J Surg 2022; 92:1007-1014. [PMID: 35373439 PMCID: PMC9111466 DOI: 10.1111/ans.17667] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022]
Abstract
Introduction The COVID‐19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS‐CoV‐2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta‐analysis aiming to characterize outcomes of COVID‐19 positive patients undergoing cardiac surgery. Methods The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID‐19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta‐analysis was conducted using a random‐effects model where at least two studies had sufficient data for that variable. Results Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion This systematic review and meta‐analysis investigated studies of limited quality which characterized cardiac surgery in COVID‐19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID‐19 on decision‐making in cardiac surgery, and effects of COVID‐19 on the cardiovascular system at a cellular level.
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Affiliation(s)
- Aashray K Gupta
- Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alasdair Leslie
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin C Y Chan
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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16
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Mehta J, Rolta R, Mehta BB, Kaushik N, Choi EH, Kaushik NK. Role of Dexamethasone and Methylprednisolone Corticosteroids in Coronavirus Disease 2019 Hospitalized Patients: A Review. Front Microbiol 2022; 13:813358. [PMID: 35242118 PMCID: PMC8886296 DOI: 10.3389/fmicb.2022.813358] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/06/2022] [Indexed: 12/15/2022] Open
Abstract
The WHO announced coronavirus disease 2019 (COVID-19) as a pandemic disease globally on March 11, 2020, after it emerged in China. The emergence of COVID-19 has lasted over a year, and despite promising vaccine reports that have been produced, we still have a long way to go until such remedies are accessible to everyone. The immunomodulatory strategy has been kept at the top priority for the research agenda for COVID-19. Corticosteroids have been used to modulate the immune response in a wide range of diseases for the last 70 years. These drugs have been shown to avoid and reduce inflammation in tissues and the bloodstream through non-genomic and genomic effects. Now, the use of corticosteroids increased the chance of survival and relief by combating the viral strong inflammatory impacts and has moved to the forefront in the management of patients seeking supplemental oxygen. The goal of this review is to illuminate dexamethasone and methylprednisolone, i.e., in terms of their chemical and physical properties, role in COVID-19 patients suffering from pneumonia, the proposed mode of action in COVID-19, pharmacokinetics, pharmacodynamics, clinical outcomes in immunocompromised populations with COVID-19, interaction with other drugs, and contradiction to explore the trends and perspectives for future research. Literature was searched from scientific databases such as Science Direct, Wiley, Springer, PubMed, and books for the preparation of this review. The RECOVERY trial, a massive, multidisciplinary, randomized, and open-label trial, is mainly accountable for recommendations over the usage of corticosteroids in COVID-19 patients. The corticosteroids such as dexamethasone and methylprednisolone in the form of medication have anti-inflammatory, analgesic, and anti-allergic characteristics, including the ability to inhibit the immune system. These drugs are also recommended for treating symptoms of multiple ailments such as rheumatic and autoimmune diseases, leukemia, multiple myeloma, and Hodgkin’s and non-Hodgkin’s lymphoma along with other drugs. Toxicology studies proved them safe usually at low dosage via oral or other routes.
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Affiliation(s)
- Jyoti Mehta
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Rajan Rolta
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | | | - Neha Kaushik
- Department of Biotechnology, The University of Suwon, Hwaseong, South Korea
| | - Eun Ha Choi
- Department of Electrical and Biological Physics, Plasma Bioscience Research Center, Kwangwoon University, Seoul, South Korea
| | - Nagendra Kumar Kaushik
- Department of Electrical and Biological Physics, Plasma Bioscience Research Center, Kwangwoon University, Seoul, South Korea
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17
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Neves MSSE, Paiva JHHGL, Ferreira NSDA, Queiroz FPA, Limeira CBB, Veras CM, Carvalho TMTD, Freitas TVDS, Esmeraldo RDM, Brasil IRC. Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2022; 64:e8. [PMID: 35137902 PMCID: PMC8815853 DOI: 10.1590/s1678-9946202264008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population.
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Affiliation(s)
- Marina Seixas Studart E Neves
- Hospital Geral de Fortaleza, Departamento de Transplantes, Fortaleza, Ceará, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Ivelise Regina Canito Brasil
- Hospital Geral de Fortaleza, Departamento de Transplantes, Fortaleza, Ceará, Brazil.,Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
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18
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Lu LY, Feng PH, Yu MS, Chen MC, Lin AJH, Chen JL, Yu LHL. Current utilization of interferon alpha for the treatment of coronavirus disease 2019: A comprehensive review. Cytokine Growth Factor Rev 2022; 63:34-43. [PMID: 35115233 PMCID: PMC8755267 DOI: 10.1016/j.cytogfr.2022.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Recent studies have identified an association between perturbed type I interferon (IFN) responses and the severity of coronavirus disease 2019 (COVID-19). IFNα intervention may normalize the dysregulated innate immunity of COVID-19. However, details regarding its utilization and therapeutic evidence have yet to be systematically evaluated. The aim of this comprehensive review was to summarize the current utilization of IFNα for COVID-19 treatment and to explore the evidence on safety and efficacy. A comprehensive review of clinical studies in the literature prior to December 1st, 2021, was performed to identify the current utilization of IFNα, which included details on the route of administration, the number of patients who received the treatment, the severity at the initiation of treatment, age range, the time from the onset of symptoms to treatment, dose, frequency, and duration as well as safety and efficacy. Encouragingly, no evidence was found against the safety of IFNα treatment for COVID-19. Early intervention, either within five days from the onset of symptoms or at hospital admission, confers better clinical outcomes, whereas late intervention may result in prolonged hospitalization.
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Affiliation(s)
- Ling-Ying Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying District, Kaohsiung City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan
| | - Ming-Sun Yu
- Division of Hematology, Conde S. Januário Hospital, Estrada do Visconde de São Januário, Macau, China
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, Taiwan
| | - Alex Jia-Hong Lin
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Justin L. Chen
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Lennex Hsueh-Lin Yu
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan,Corresponding author
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19
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Muhammad A, Forcados GE, Sani H, Ndidi US, Adamu A, Katsayal BS, Sadiq IZ, Abubakar YS, Sulaiman I, Abubakar IB, Yusuf AP, Malami I, Ibrahim S, Abubakar MB. Epigenetic modifications associated with genes implicated in cytokine storm: The potential biotherapeutic effects of vitamins and minerals in COVID‐19. J Food Biochem 2022; 46:e14079. [DOI: 10.1111/jfbc.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Aliyu Muhammad
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Hadiza Sani
- Department of Medicine Kaduna State University Kaduna Nigeria
| | - Uche Samuel Ndidi
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | - Auwal Adamu
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Idris Zubairu Sadiq
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Ibrahim Sulaiman
- Department of Human Physiology Federal University Dutse Dutse Nigeria
| | | | | | - Ibrahim Malami
- Department of Pharmacognosy and Ethnopharmacy, Faculty of Pharmaceutical Sciences Usmanu Danfodiyo University Sokoto Nigeria
| | - Sani Ibrahim
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
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20
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Li J, Wu H, Zhang J. Efficacy of phentolamine combined with ambroxol aerosol inhalation in the treatment of pediatric severe pneumonia and its effect on serum IL-10 and CRP levels. Transl Pediatr 2022; 11:33-40. [PMID: 35242650 PMCID: PMC8825933 DOI: 10.21037/tp-21-516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine the therapeutic effect of phentolamine combined with Ambroxol aerosol inhalation on pediatric severe pneumonia and its effect on serum interleukin-10 (IL-10) and C-reactive protein (CRP) levels. METHODS Eighty-five children with severe pneumonia treated in our hospital from November 2019 to November 2020 were selected as the research participants, and were divided into the routine group (n=41) and treatment group (n=44) according to odd and even admission numbers, respectively. Children in the first group received routine treatment, namely symptomatic treatment such as cough relief (e.g., expectorant) and defervescence, while those in the second group received phentolamine combined with Ambroxol aerosol inhalation. Clinical indexes of both groups before and after treatment were analyzed to determine the therapeutic effect of different treatment methods and serum IL-10 and CRP level changes. RESULTS There was no significant difference in general clinical data between the 2 groups (P>0.05). The duration of cough, fever, abnormal lung sound and lung shadow, and hospitalization time in the treatment group was significantly shorter than those in the routine group (P<0.001). The total clinical effective rate in the treatment group was significantly higher than that in the routine group (P<0.05). Forced vital capacity and peak expiratory flow rate levels were higher in both groups after treatment (P<0.05), and these were higher in the treatment group compared with the routine group after treatment (P<0.05). Serum IL-10 and CRP levels at T1 (2 days after treatment), T2 (5 days after treatment), and T3 (7 days after treatment) in the treatment group were significantly lower than those in the routine group (P<0.001). The total incidence of adverse reactions in the treatment group was significantly lower than that in the routine group (P<0.05). CONCLUSIONS Phentolamine combined with Ambroxol aerosol inhalation can significantly improve the clinical symptoms of children with severe pneumonia, reduce the body's inflammatory response, and improve lung function safely.
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Affiliation(s)
- Junxia Li
- Department of Pediatrics, Yantai Mountain Hospital, Yantai, China
| | - Haixia Wu
- Department of Pediatrics, Yantai Mountain Hospital, Yantai, China
| | - Jingyao Zhang
- Department of ICU Medicine, The Fourth People's Hospital of Jinan, Jinan, China
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21
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Sheikhalipour Z, Faghihdinevari M, Salehi-Pourmehr H, Khameneh M, Vahedi L. Covid-19 in kidney transplant recipients with immunosuppressive therapy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:161-172. [PMID: 35872680 PMCID: PMC9272967 DOI: 10.22088/cjim.12.4.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Since the outbreak of COVID-19, various treatments have been frequently reported for patients infected with this virus, especially in transplant patients/recipients. Objective: Investigating of kidney transplant patients under immunosuppressive therapy infected with COVID-19 can pave the way to understanding, handling, and treatment of COVID-19. METHODS We had a brief review of the literature on immunosuppressive therapy in kidney transplants infected with COVID-19. This was based on the PubMed Database with keywords "kidney, transplant, COVID-19, and immunosuppress" after hospitalization of kidney transplantation infected with COVID-19. He had already been recorded in the Organ Transplant Registry (ID≠ 64510) of Tabriz University of Medical Sciences /Iran. RESULTS We reported the clinical course of a 45-year-old man with a history of kidney transplantation and immunotherapy who was infected with COVID-19 with respiratory infections and positive RT-PCR (Real-time polymerase chain reaction). He was treated with hydroxychloroquine, Kaletra, CellCept, and prednisolone for 5 days, and finally discharged from the hospital. In addition, reviewing of 47 papers with 851 samples showed that immunosuppressant medications alone could be a therapeutic choice in kidney transplants infected with COVID-19 with careful management. CONCLUSION Patients with organ transplantation infected with COVID-19 may show different clinical signs, clinical course, and prognosis due to underlying diseases and the use of immunosuppressant medications. It might be best to continue taking the immunosuppressant medications but modify them based on the patients' conditions such as clinical symptoms, laboratory results, paraclinical examinations.
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Affiliation(s)
- Zahra Sheikhalipour
- Medical and Surgical Department, Nursing and Midwifery School, Organ Transplant Registry, Tabriz University of Medical Sciences, Iran
| | - Masood Faghihdinevari
- Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Khameneh
- Student Research Committee, Islamic Azad University of Tabriz, Tabriz, Iran
| | - Leila Vahedi
- Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran,Correspondence: Leila Vahedi, Liver and Gastrointestinal Diseases Research Center, Organ Transplant Registry, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail: , Tel: 0098 4133351688, Fax: 0098 4133373741
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22
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Daoud A, Alqassieh A, Alkhader D, Posadas Salas MA, Rao V, Fülöp T, Soliman KM. Immunosuppression in kidney transplant recipients with COVID-19 infection - where do we stand and where are we heading? Ren Fail 2021; 43:273-280. [PMID: 33491531 PMCID: PMC7850379 DOI: 10.1080/0886022x.2021.1876730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/02/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
The appropriate immunosuppressive regimen in kidney transplant recipients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19) infection remains unclear. The impact of direct virus injury complicated by dysregulated hyperimmune response with overwhelming release of various cytokines in COVID-19 infected subjects contributes to the complexity of management. The largest concern of the practicing clinicians at current time is how to tailor maintenance immune-modulating therapy during active viral infection and the efficacy of the soon-to-be upcoming immunization for COVID-19. This targeted review aims to cover most of the current evidence on the effect of key maintenance immunosuppressive agents in COVID-19 infection and proposes a line of management to specific scenarios on this very rapidly evolving subject.
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Affiliation(s)
- Ahmed Daoud
- Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Duaa Alkhader
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Aurora Posadas Salas
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Vinaya Rao
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Karim M. Soliman
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
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23
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Sagnelli C, Sica A, Gallo M, Peluso G, Varlese F, D'Alessandro V, Ciccozzi M, Crocetto F, Garofalo C, Fiorelli A, Iannuzzo G, Reginelli A, Schonauer F, Santangelo M, Sagnelli E, Creta M, Calogero A. Renal involvement in COVID-19: focus on kidney transplant sector. Infection 2021; 49:1265-1275. [PMID: 34611792 PMCID: PMC8491762 DOI: 10.1007/s15010-021-01706-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. MATERIALS AND METHODS The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. CONCLUSION This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n. 1, 80138, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Monica Gallo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131, Naples, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Vincenzo D'Alessandro
- UOSD Centro Trapianti di rene e Chirurgia del Retroperitoneo, AOU-University of Naples Federico II, 80131, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 80128, Rome, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131, Naples, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania "Luigi Vanvitelli", 80137, Naples, Italy
| | - Alfonso Fiorelli
- Department of Thoracic Surgery, University of Campania "Luigi Vanvitelli", 80137, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University Naples, Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Fabrizo Schonauer
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Naples Federico II, 80131, Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n. 1, 80138, Naples, Italy.
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy
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24
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Adedoyin O, Brijmohan S, Lavine R, Lisung FG. Undetectable SARS-CoV-2 active adaptive immunity-post-vaccination or post-COVID-19 severe disease-after immunosuppressants use. BMJ Case Rep 2021; 14:14/11/e246308. [PMID: 34844968 PMCID: PMC8634224 DOI: 10.1136/bcr-2021-246308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.
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Affiliation(s)
- Oluwafeyi Adedoyin
- Internal Medicine Residency Program, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Sharmela Brijmohan
- Internal Medicine Residency Program, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Ross Lavine
- Internal Medicine Residency Program, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
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25
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Godara S, Saraf KK, Sadasukhi TC, Gupta HL, Gupta M, Sadasukhi N, Sharma A. COVID-19 Infection in Kidney Transplant Recipients: A Single Centre Study from Northern India. Indian J Nephrol 2021; 31:531-535. [PMID: 35068759 PMCID: PMC8722553 DOI: 10.4103/ijn.ijn_571_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. The pre-immunosuppressed state along with other existing co-morbidities can influence the outcomes of COVID-19 in transplant patients. MATERIAL AND METHODS This was a single centre prospective cohort study done in kidney transplant recipients (KTRs), who underwent kidney transplantation (from December 2012 to November 2020), who were actively followed up at our centre and were diagnosed with COVID-19 disease between 1 April and 30 November 2020. RESULTS A total of 62 kidney-transplant recipients tested positive for COVID-19. Their median age was 39 (19-61). Males were predominantly infected (87.1%). Fever was the most common symptom (77.42%). Thirteen (20.9%) had mild form of disease, 32 (51.6%) had moderate form and 17 (27.4%) had severe disease. Based on initial symptom, 18 (29.03%) were given home treatment, 29 (46.7%) were treated in isolation wards and 15 (24.1%) were treated in intensive care unit. Decrease in the dose of immunosuppressant (anti-metabolites in 67.7%, calcineurin inhibitor in 22.5%) was predominantly carried out as the initial mode of treatment. Remdesivir in 64.5% and anticoagulant therapy in 54.84% were given as a modality of treatment. Mortality rate in our study was 14.5%. CONCLUSIONS Patients of kidney transplant are at high risk of getting infected with COVID-19, due to their immunosuppressed state. Initial symptoms in KTRs with COVID-19 are similar to that of the general population. Mortality rate is comparatively higher in KTRs as compared to general population.
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Affiliation(s)
- Suraj Godara
- Department of Nephrology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Karan Kumar Saraf
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - T. C. Sadasukhi
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - H. L. Gupta
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Manish Gupta
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Nripesh Sadasukhi
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Ashish Sharma
- Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
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26
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Giri R, Kumar A, Saini M, Sharma RK. Living with the virus: Infection and epidemiology of COVID-19 in hotspot area of India. JOURNAL OF PUBLIC AFFAIRS 2021; 21:e2651. [PMID: 33786027 PMCID: PMC7994984 DOI: 10.1002/pa.2651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/06/2021] [Accepted: 02/10/2021] [Indexed: 05/12/2023]
Abstract
The coronavirus disease (COVID-19) has been identified as a pandemic and affected almost whole world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of this disease, is infecting Indian population since the last week of January 2020. The data were collected from January 30, 2020, to May 23, 2020, to analyze basic trend of COVID-19 cases in India targeting hotspot regions. To find the linear relationship between variables, that is, age, total positive cases, population, and population density data have been statistically analyzed. COVID-19 caused more than 5000 deaths till May 2020 in India. SARS-CoV-2 spread to several Indian cities with more than 100,000 positive cases. Total number of COVID-19 cases and total recovered cases followed the exponential distribution, while number of deaths showed linear behavior. Nearly 50% of the youth, that is, 20-40 years of age had been found to recover from the infection. As a lockdown cannot be a permanent solution, it is important to understand the nature of virus and learn "living with the virus" while minimizing its spreading at the same time.
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Affiliation(s)
- Rajat Giri
- Department of BiosciencesManipal University JaipurJaipurIndia
| | - Ashish Kumar
- Department of Mathematics and StatisticsManipal University JaipurJaipurIndia
| | - Monika Saini
- Department of Mathematics and StatisticsManipal University JaipurJaipurIndia
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27
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Ganjei Z, Faraji Dana H, Ebrahimi-Dehkordi S, Alidoust F, Bahmani K. Methotrexate as a safe immunosuppressive agent during the COVID-19 pandemic. Int Immunopharmacol 2021; 101:108324. [PMID: 34731780 PMCID: PMC8556580 DOI: 10.1016/j.intimp.2021.108324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
Abstract
Background During the ongoing COVID-19 pandemic, immunocompromised patients are at a higher risk of severe infection, since the immune system has an important role in defeating this disease. This study compares the severity of COVID-19 in patients taking methotrexate with the severity of their family members’ illness as patients with normal immune system function. Methods A total of 35 participants, including 14 patients taking methotrexate and 21 patients with normal immune function, entered this study, and the indicators of COVID-19 severity were compared between these two groups. Results The case group, who were on methotrexate therapy, had significantly less severe COVID-19 based on their symptoms, including fever (p = 0.000) and cough and dyspnea (p = 0.01) as well as in terms of COVID-19 severity indicators such as pulmonary involvement (p = 0.001), ferritin level (p = 0.001), white blood cell count (p = 0.008) and CRP level (p = 0.006), compared to the control group. There was a significant correlation between taking methotrexate and lower severity in COVID-19 disease. Conclusion The present findings demonstrated that methotrexate does not predispose patients to severe COVID-19; on the contrary, patients taking methotrexate may experience a milder disease, possibly due to their reduced severe inflammatory reactions as a result of inhibited TNFα, lowered IL6, and increased T regulatory cells. According to these findings, methotrexate appears to be a suitable treatment option for patients who need immunosuppressive medications during the COVID-19 pandemic.
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Affiliation(s)
- Zakiye Ganjei
- Department of Dermatology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hoorvash Faraji Dana
- Clinical Toxicology Fellowship, Emergency Department, Alborz University of Medical Science, Karaj, Iran
| | | | - Fereshte Alidoust
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Kiumars Bahmani
- Department of Pharmacology and Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Science, Tehran, Iran.
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28
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Tseng HT, Wu XC, Huang CY, Shih CM, Lin YW, Lin FY. The Impact of SARS-CoV-2 Infection, and Application of Immunosuppressive Agents in Kidney Transplant Recipients Suffering from COVID-19. Pharmaceuticals (Basel) 2021; 14:ph14101054. [PMID: 34681278 PMCID: PMC8537512 DOI: 10.3390/ph14101054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
In December 2019, the COVID-19 pandemic began to ravage the world quickly, causing unprecedented losses in human life and the economy. A statistical study revealed that the proportion of solid organ transplant (SOT) recipients with severe symptoms and deaths after being infected by SARS-CoV-2 is considerably higher than that of non-SOT recipients, and the prognosis is relatively poor. In addition, the clinical manifestation of SOT recipients suffering from COVID-19 is different from that of general COVID-19 patients. Acute kidney injury (AKI) is a common complication in COVID-19 patients, and it is likely more common among SOT recipients infected with SARS-CoV-2. Clinical experts consider that SOT recipients have long-term treatment with immunosuppressants, and the comorbidities are driven by a high rate of severe symptoms and mortality. Orthotopic kidney allograft transplantation is an effective treatment for patients suffering from end-stage kidney disease/kidney failure through which they can easily extend their life. Indeed, kidney transplant recipients have suffered significant damage during this pandemic. To effectively reduce the severity of symptoms and mortality of kidney transplant recipients suffering from COVID-19, precise application of various drugs, particularly immunosuppressants, is necessary. Therefore, herein, we will collate the current clinical experience of treating COVID-19 infection in kidney transplant recipients and discuss the adjustment of patients using immunosuppressive agents in the face of COVID-19.
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Affiliation(s)
- Horng-Ta Tseng
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Xiang-Chi Wu
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Yao Huang
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Ming Shih
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yi-Wen Lin
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Institute of Oral Biology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: (Y.-W.L.); (F.-Y.L.); Tel.: +886-2-87910329 (Y.-S.J.)
| | - Feng-Yen Lin
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (Y.-W.L.); (F.-Y.L.); Tel.: +886-2-87910329 (Y.-S.J.)
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29
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Ahmadian E, Zununi Vahed S, Mammadova S, Abediazar S. Immunosuppressant Management in Renal Transplant Patients with COVID-19. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9318725. [PMID: 34692845 PMCID: PMC8531766 DOI: 10.1155/2021/9318725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.
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Affiliation(s)
- Elham Ahmadian
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shakar Mammadova
- Department of Physical Geography, Baku State University, Baku, Azerbaijan
| | - Sima Abediazar
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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30
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Alkadi MM, Al-Malki HA, Asim M, Fituri OM, Hamdi AF, Elidrisi RI, Abdul Rahiman R, Elshirbeny MF, Othman MA, Nauman A, Ashour A, Ghonimi TA, Tohid H, Jarman ME, Hamad A, Elshazly MB, Abuhelaiqa E. Kidney Transplant Recipients Infected With Coronavirus Disease 2019: Retrospective Qatar Experience. Transplant Proc 2021; 53:2438-2446. [PMID: 34275597 PMCID: PMC8193030 DOI: 10.1016/j.transproceed.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aimed to evaluate the incidence of coronavirus disease 2019 (COVID-19) infection on kidney transplant, mortality, and risk factors associated with infection acquisition and severe illness in kidney transplant recipients with COVID-19. METHODS Of 693 kidney transplant recipients who reported to our center, 249 were tested for COVID-19 by throat and nasal swab reverse transcription polymerase chain reaction. Of these, 43 recipients tested positive and 206 recipients tested negative. Among the 43 positive recipients, 9 were treated within an isolation facility, 25 were admitted to the hospital, and 9 were admitted to the intensive care unit (ICU). Risk factors associated with positive results and ICU admission were evaluated. RESULTS COVID-19 was found in 6% of transplant recipients. Asian ethnicity (p = .003), history of hypertensive nephropathy (p = .01), AB blood group (P = .04), and higher tacrolimus trough levels (P = .007) were more frequent in the COVID-19 positive than in the COVID-19 negative group. ICU admission was more frequent in recipients presenting with fever, shortness of breath, and acute allograft dysfunction. Renal replacement therapy was required in 3 (7%) of 43 recipients, and mortality was reported in 1 (2.3%) recipient. Acute allograft dysfunction was an independent risk factor for severe COVID-19 (odds ratio, 93.7; 95% confidence interval, 2.37-3710.94; P = .02). CONCLUSIONS Higher tacrolimus targets may be associated with COVID-19 development. Acute kidney injury during the COVID-19 course may be a sign of severe disease. Prognostication of COVID-19 severity in kidney transplant recipients is crucial for early recognition of critical illness and may ensure early intervention.
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Affiliation(s)
- Mohamad M Alkadi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Hassan A Al-Malki
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Muhammad Asim
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Omar M Fituri
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Ahmed F Hamdi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Rihab I Elidrisi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ramzi Abdul Rahiman
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mostafa F Elshirbeny
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Muftah A Othman
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar
| | - Awais Nauman
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Adel Ashour
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Tarek A Ghonimi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hiba Tohid
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mona E Jarman
- Division of Transplantation Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdullah Hamad
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Essa Abuhelaiqa
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
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31
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Siddiqui AJ, Jahan S, Ashraf SA, Alreshidi M, Ashraf MS, Patel M, Snoussi M, Singh R, Adnan M. Current status and strategic possibilities on potential use of combinational drug therapy against COVID-19 caused by SARS-CoV-2. J Biomol Struct Dyn 2021; 39:6828-6841. [PMID: 32752944 PMCID: PMC7484586 DOI: 10.1080/07391102.2020.1802345] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 01/01/2023]
Abstract
The spread of new coronavirus infection starting December 2019 as novel SARS-CoV-2, identified as the causing agent of COVID-19, has affected all over the world and been declared as pandemic. Approximately, more than 8,807,398 confirmed cases of COVID-19 infection and 464,483 deaths have been reported globally till the end of 21 June 2020. Until now, there is no specific drug therapy or vaccine available for the treatment of COVID-19. However, some potential antimalarial drugs like hydroxychloroquine and azithromycin, antifilarial drug ivermectin and antiviral drugs have been tested by many research groups worldwide for their possible effect against the COVID-19. Hydroxychloroquine and ivermectin have been identified to act by creating the acidic condition in cells and inhibiting the importin (IMPα/β1) mediated viral import. There is a possibility that some other antimalarial drugs/antibiotics in combination with immunomodulators may help in combatting this pandemic disease. Therefore, this review focuses on the current use of various drugs as single agents (hydroxychloroquine, ivermectin, azithromycin, favipiravir, remdesivir, umifenovir, teicoplanin, nitazoxanide, doxycycline, and dexamethasone) or in combinations with immunomodulators additionally. Furthermore, possible mode of action, efficacy and current stage of clinical trials of various drug combinations against COVID-19 disease has also been discussed in detail.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Arif Jamal Siddiqui
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| | - Sadaf Jahan
- Department of Medical Laboratory, College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Syed Amir Ashraf
- Department of Clinical Nutrition, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Mousa Alreshidi
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| | - Mohammad Saquib Ashraf
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, Shaqra University, Al Dawadimi, Saudi Arabia
| | - Mitesh Patel
- Bapalal Vaidya Botanical Research Centre, Department of Biosciences, Veer Narmad South Gujarat University, Surat, Gujarat, India
| | - Mejdi Snoussi
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
- Laboratory of Genetics, Biodiversity and Valorization of Bio-resources, Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, Tunisia
| | - Ritu Singh
- Department of Environmental Sciences, School of Earth Sciences, Central University of Rajasthan, Ajmer, India
| | - Mohd Adnan
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
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32
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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: 1.8] [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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Turkkan S, Beyoglu MA, Sahin MF, Yazicioglu A, Tezer Tekce Y, Yekeler E. COVID-19 in lung transplant recipients: A single-center experience. Transpl Infect Dis 2021; 23:e13700. [PMID: 34323353 PMCID: PMC8420517 DOI: 10.1111/tid.13700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global health problem. However, the course of this disease in immunosuppressed patients remains unknown. This study aimed to describe the course of COVID-19 infection and its effects on lung transplant recipients. METHODS This was a single-center, retrospective, observational study. The recipients with suspicious symptoms and/or a contact history with infected individuals were diagnosed with COVID-19 by performing a reverse transcription-polymerase chain reaction (RT-PCR) test using samples obtained from the nasopharynx swabs or bronchial lavage. We classified the patients into mild, moderate, and high severity groups according to their clinical conditions. In patients with positive RT-PCR results, cell cycle inhibitor drugs were withdrawn, while steroids were maintained at the same level as in patients without clinical deterioration. RESULTS Of the seven recipients diagnosed with COVID-19 infection, one experienced a re-infection. Each recipient had at least one comorbidity. Smell disorder (12.5%), cough/dyspnea (37%), and fever/chills/shivering (37%) were the most frequent symptoms. The mean follow-up time after infection was 108 days. No deaths were recorded due to COVID-19; however, the pulmonary function test values of two recipients were decreased during subsequent follow-ups. CONCLUSION In our small group of transplant recipients with COVID-19, there were two cases of pulmonary function deterioration and a case of re-infection, and no recipient died. It is suggested that steroid therapy should be initiated in the early period in patients with pulmonary opacities.
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Affiliation(s)
- Sinan Turkkan
- Department of Thoracic Surgery and Lung TransplantationAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Muhammet Ali Beyoglu
- Department of Thoracic Surgery and Lung TransplantationAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Mehmet Furkan Sahin
- Department of Thoracic Surgery and Lung TransplantationAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Alkın Yazicioglu
- Department of Thoracic Surgery and Lung TransplantationAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Yasemin Tezer Tekce
- Department of Infectious DiseasesAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
| | - Erdal Yekeler
- Department of Thoracic Surgery and Lung TransplantationAnkara City HospitalUniversity of Health SciencesAnkaraTurkey
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Les facteurs pronostiques dans la Covid-19. NPG NEUROLOGIE - PSYCHIATRIE - GÉRIATRIE 2021. [PMCID: PMC8206591 DOI: 10.1016/j.npg.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Depuis la fin de l’année 2019, la France, de même que l’ensemble des pays du monde, est confrontée à une situation épidémiologique inédite : la Covid-19. Les personnes les plus vulnérables, et notamment les personnes âgées sont particulièrement touchées par cette épidémie. Bien que de nombreux patients se rétablissent complètement, plusieurs facteurs conduisent à un mauvais pronostic. Diverses études ont proposé comme objectif d’identifier les facteurs pronostiques de mortalité et d’évolution vers une maladie grave pour les patients diagnostiqués avec la Covid-19. Certains de ces facteurs pronostiques peuvent être utilisés dans la prise de décision relative à la prise en charge des patients infectés par la Covid-19.
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Kurd R, Freed Y, Jarjoui A, Izbicki G, Levin P, Helvitz Y, Sherr J, Oberbaum M. Homeopathic Treatment for COVID-19-Related Symptoms: A Case Series. Complement Med Res 2021; 29:83-88. [PMID: 34521083 PMCID: PMC8678262 DOI: 10.1159/000517924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome due to coronavirus 2 (SARS CoV-2) is a novel infectious disease, which has quickly developed into a pandemic. The spectrum of COVID-19 symptoms is broad, ranging from a mild, self-limiting respiratory tract illness to severe progressive pneumonia, multi-organ failure and possible death. Despite much effort and multiple clinical trials, there are, to date, no specific therapeutic agents to treat or cure the coronavirus infection. CASE REPORTS The present paper presents 5 cases of patients with moderate to severe COVID-19 infections, 2 of them hospitalized in the intensive care unit, who were successfully treated with homeopathy. RESULTS All 5 patients responded to homeopathic treatment in an unexpectedly short time span, improving both physically and mentally. CONCLUSION The present case series emphasizes the rapidity of response among moderate to severely ill patients to homeopathic treatment, when conventional medical options have been unable to relieve or shorten the disease. The observations described should encourage use of homeopathy in treating patients with COVID-19 during the acute phase of the disease.
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Affiliation(s)
- Ramzi Kurd
- Internal Medicine Division, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yakov Freed
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amir Jarjoui
- Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gabriel Izbicki
- Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Philip Levin
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yigal Helvitz
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Menachem Oberbaum
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Naghashzadeh F, Shafaghi S, Sharif-Kashani B, Tabarsi P, Saliminejad L, Noorali S. Coronavirus disease 2019 outcomes in heart transplant recipients: a single-center case series. J Med Case Rep 2021; 15:453. [PMID: 34511111 PMCID: PMC8435348 DOI: 10.1186/s13256-021-03028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background With the rapidly expanding pandemic of severe acute respiratory syndrome coronavirus-2, a chronic immunosuppressed state in solid organ transplant recipients is a concern. We reported coronavirus disease 2019 in heart transplant recipients and described the patients’ course from diagnosis to either hospital admission or improvement in symptoms. Case presentation This study retrospectively identified 13 white (Iranian) heart transplant patients with coronavirus disease 2019 between December 2019 and October 2020. The mean age of patients was 43.7 years (19–65 years); seven (70%) were men. Laboratory and treatment data were collected for those admitted or managed as outpatients. Outcomes were also recorded for all patients. This report demonstrates a range of symptoms, clinical severity, and disease course in heart transplant recipients with coronavirus disease 2019, including ten hospitalized patients and three patients, managed entirely in the outpatient setting. One patient passed away, and none of them experienced an episode of clinically overt rejection. Conclusions We would like to emphasize the importance of being alert in these patients to consider testing in a broad range of clinical presentations and gathering more data for better management.
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Affiliation(s)
- Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Infectious Disease Specialist, Fellowship of Infection in Immunocompromised Host, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Saliminejad
- Bachelor of Science in Nursing (BSN), Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Farzan N, Vahabi S, Farzan B, Madani S. Evaluation of invasive ventilation rate and comorbidities, clinical signs and lab findings among COVID-19 patients. New Microbes New Infect 2021; 43:100925. [PMID: 34336225 PMCID: PMC8302482 DOI: 10.1016/j.nmni.2021.100925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The severity of COVID-19 has been to be associated with comorbidities. It is defined as the presentation of severe respiratory dysfunction or failure, leading to the need for ventilation and mortality. The aim of this study is the evaluate the factors predicting the rate of invasive ventilation among these patients. This retrospective study involved 317 COVID-19 patients referred to (XXX) Hospital in Qom, Iran. The following data were obtained for all the patients: demographic parameters, comorbidities, need for mechanical ventilation, signs and symptoms and lab findings. The results from the demographic data of the study indicated that the need for mechanical ventilation is significantly associated with advanced age, p = 0.001. Additionally, hypertension, leukopenia and blood urea nitrogen to creatinine ratio p = 0.008. p = 0.042 and p < 0.001, respectively, are significantly associated with an increased need for mechanical ventilation. Malignancy, diabetes, asthma, chronic obstructive pulmonary disease, headache, fever, platelet count, prothrombin time, c-reactive protein, erythrocyte sedimentation rate and creatinine phosphatase were not significantly different in the two groups, p > 0.05. Prediction of the extent of severity among COVID-19 patients using clinical parameters and comorbidities prepare medical practitioners and health care centres to take immediate measurements and reduce the burden of the scarcity of health supplies and care.
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Affiliation(s)
- N. Farzan
- Department of Emergency Medicine, Clinical Research Development Centre, Qom University of Medical Sciences, Qom, Iran
| | - S. Vahabi
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - B. Farzan
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - S.S.H. Madani
- Emergency Medicine Department, Student Research Development Centre, Qom University of Medical Sciences, Qom, Iran
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Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2021; 39:3127-3138. [PMID: 32462305 PMCID: PMC7251800 DOI: 10.1007/s00345-020-03246-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE AND OBJECTIVE We performed a systematic review on COVID-19 and its potential urological manifestations. METHODS A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. RESULTS There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30-13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46-100%) amongst them. 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71-83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. CONCLUSIONS Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
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Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2021. [PMID: 32462305 DOI: 10.1007/s00345-%20020-%2003246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
PURPOSE AND OBJECTIVE We performed a systematic review on COVID-19 and its potential urological manifestations. METHODS A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. RESULTS There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30-13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46-100%) amongst them. 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71-83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. CONCLUSIONS Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
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Değirmenci MFK, Yalçındağ FN, Tugal-Tutkun İ. COVID-19 and the Use of Immunomodulatory Agents in Ophthalmology. Turk J Ophthalmol 2021; 51:231-242. [PMID: 34461710 PMCID: PMC8411289 DOI: 10.4274/tjo.galenos.2021.68252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/μL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.
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Affiliation(s)
| | - F Nilüfer Yalçındağ
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İlknur Tugal-Tutkun
- İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can generate a wide spectrum of clinical manifestations ranging from asymptomatic to severe respiratory and systemic disease with coagulation disorder named coronavirus disease 2019 (COVID-19). Patients with comorbidities have been identified as risk groups for severe COVID-19, also having a higher death risk. Previous reports have conflicting results regarding if solid organ transplant recipients present an increased risk for COVID-19. Nevertheless, previous investigations failed to distinguish between different organs received or made a longitudinal investigation on those patients. We recruited 39 solid organ transplant recipients: 25 kidney transplant recipients, 7 heart transplant recipients, and 7 liver transplant recipients and 25 age-matched non-transplant COVID-19 patients without comorbidities (control group) and compared daily laboratory data in addition to performing survival analysis. Heart and kidney transplant recipients presented an increase in several COVID-19 severity-associated biomarkers, such as neutrophil-to-lymphocyte ratio and thrombocytopenia, in comparison to the control group and liver transplant recipients. Heart and kidney transplant recipients also presented an increase in the need for intensive care and invasive mechanical ventilation during the disease’s course. Importantly, heart and kidney transplant recipients presented a higher mortality rate in comparison to liver transplant recipients and non-transplant recipients. In our cohort, heart and kidney transplant recipients presented a difference in clinical characteristics and survival rate in comparison to liver transplant recipients. Further investigation involving immune response to SARS-CoV-2 in solid organ recipients should consider and separate patients according to the organ grafted.
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Wang T, Qiu T, Yuan Y, Chen Z, Ma X, Zhang L, Jin Z, Zou J, Zhang Y, Zhou J. Summary report of seven cases of COVID-19 infection in renal transplant recipients. Transpl Immunol 2021; 69:101445. [PMID: 34384886 PMCID: PMC8352666 DOI: 10.1016/j.trim.2021.101445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 12/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has swept the world, posing a serious threat to people's lives and health. Several cases of COVID-19 infection in renal transplant recipients (RTRs) have been reported, but the treatment and prognosis have not been fully elucidated. We followed-up with RTRs infected with SARS-CoV2 in our center and classified them as five clinical types—asymptomatic, mild, moderate, severe, and critical. The immunosuppressive agents were not adjusted in asymptomatic carriers and mild patients, the former was mainly treated by isolation, and the latter was treated by low-dose intravenous immunoglobulin (IVIG) to enhance immunity. For moderate or severe patients, the immunosuppressive agents were largely reduced or even interrupted, low-dose IVIG was adopted, and low-dose methylprednisolone (MP) was used to inhibit inflammation and rejection. Immunosuppressants were discontinued early in critical patients; IVIG, high-dose MP, and antibiotics were used. Meanwhile, all patients received at least one antiviral drugs. After aggressive treatment, three patients developed acute kidney injury, and two showed reversal, while the remaining one lost the allograft kidney; one patient died, while other patients were discharged. For different clinical types of RTRs infected with COVID-19, personalized therapies were essential, Meanwhile, patients with COVID-19 infection may have different outcomes due to their different clinical manifestations.
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Affiliation(s)
- Tianyu Wang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Tao Qiu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Yan Yuan
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Zhongbao Chen
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Xiaoxiong Ma
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Long Zhang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Zeya Jin
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Jilin Zou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Yalong Zhang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Jiangqiao Zhou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China.
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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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Anft M, Blazquez-Navarro A, Stervbo U, Skrzypczyk S, Witzke O, Wirth R, Choi M, Hugo C, Reinke P, Meister TL, Steinmann E, Pfaender S, Schenker P, Viebahn R, Westhoff TH, Babel N. Detection of pre-existing SARS-CoV-2-reactive T cells in unexposed renal transplant patients. J Nephrol 2021; 34:1025-1037. [PMID: 34228322 PMCID: PMC8259083 DOI: 10.1007/s40620-021-01092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent data demonstrate potentially protective pre-existing T cells reactive against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in samples of healthy blood donors, collected before the SARS-CoV-2 pandemic. Whether pre-existing immunity is also detectable in immunosuppressed patients is currently not known. METHODS Fifty-seven patients were included in this case-control study. We compared the frequency of SARS-CoV-2-reactive T cells in the samples of 20 renal transplant (RTx) patients to 20 age/gender matched non-immunosuppressed/immune competent healthy individuals collected before the onset of the SARS-CoV-2 pandemic. Seventeen coronavirus disease 2019 (COVID-19) patients were used as positive controls. T cell reactivity against Spike-, Nucleocapsid-, and Membrane- SARS-CoV-2 proteins were analyzed by multi-parameter flow cytometry. Antibodies were analyzed by neutralization assay. RESULTS Pre-existing SARS-CoV-2-reactive T cells were detected in the majority of unexposed patients and healthy individuals. In RTx patients, 13/20 showed CD4+ T cells reactive against at least one SARS-CoV-2 protein. CD8+ T cells reactive against at least one SARS-CoV-2 protein were demonstrated in 12/20 of RTx patients. The frequency and Th1 cytokine expression pattern of pre-formed SARS-CoV-2 reactive T cells did not differ between RTx and non-immunosuppressed healthy individuals. CONCLUSIONS This study shows that the magnitude and functionality of pre-existing SARS-CoV-2 reactive T cell in transplant patients is non-inferior compared to the immune competent cohort. Although several pro-inflammatory cytokines were produced by the detected T cells, further studies are required to prove their antiviral protection.
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Affiliation(s)
- Moritz Anft
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Arturo Blazquez-Navarro
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117, Berlin, Germany
| | - Ulrik Stervbo
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Sarah Skrzypczyk
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Rainer Wirth
- Department of Geriatrics, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Mira Choi
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Hugo
- Department of Nephrology, Medical Department III, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Petra Reinke
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117, Berlin, Germany
| | - Toni Luise Meister
- Department of Molecular and Medical Virology, Ruhr University Bochum, Universitätsstrasse 50, 44801, Bochum, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Universitätsstrasse 50, 44801, Bochum, Germany
| | - Stephanie Pfaender
- Department of Molecular and Medical Virology, Ruhr University Bochum, Universitätsstrasse 50, 44801, Bochum, Germany
| | - Peter Schenker
- Department Surgery, Knappschaftskrankenhaus Bochum, University Hospital of the Ruhr-University Bochum, In der Schornau 23, 44892, Bochum, Germany
| | - Richard Viebahn
- Department Surgery, Knappschaftskrankenhaus Bochum, University Hospital of the Ruhr-University Bochum, In der Schornau 23, 44892, Bochum, Germany
| | - Timm H Westhoff
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Nina Babel
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz 1, 10117, Berlin, Germany.
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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Abolghasemi S, Zolfaghari F, Naeimipoor M, Azhdari Tehrani H, Hakamifard A. COVID-19 reinfection or reactivation in a renal transplant patient. Clin Case Rep 2021; 9:e04672. [PMID: 34430026 PMCID: PMC8365855 DOI: 10.1002/ccr3.4672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/09/2022] Open
Abstract
Recurrences of COVID-19 infection may occur in immunocompromised patients. Reinfection or reactivation of COVID-19 virus is a challenging issue in these patients.
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Affiliation(s)
- Sara Abolghasemi
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Farnaz Zolfaghari
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Naeimipoor
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Hamed Azhdari Tehrani
- Department of Hematology and Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
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Ebrahimiadib N, Fadakar K, Riazi-Esfahani H, Zarei M, Maleki A, Bojabadi L, Ahmadi A, Look-Why S, Foster CS. COVID-19 and Immunosuppressive Therapy in Ocular Inflammatory Disease, a Telemedicine Survey. Ocul Immunol Inflamm 2021; 29:734-740. [PMID: 34328808 DOI: 10.1080/09273948.2021.1949477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Determine the risk of immunomodulatory therapy (IMT) for COVID-19 infection morbidity.Method: A telemedicine survey on patients of a referral uveitis clinic was performed. Signs of infection, habits, and hospitalizations during the 7 months of the COVID-19 pandemic prior to the study date were recorded. Suggestive findings in chest CT scan and/or positive RT-PCR were considered as confirmed COVID-19 infection while those with only suggestive symptoms were considered as suspected cases. Risk factors including sanitary measures and IMT were compared between patients with confirmed cases and patients without infection.Result: 694 patients were included. Eight patients were identified as confirmed cases and 22 patients as suspected cases of COVID-19 infection. Close contact with infected persons was the only significant risk factor for contracting COVID-19.Conclusion: Using IMT did not affect hospitalization and/or ICU admission and can thus be continued during the pandemic, provided that instructions for preventive measures are followed.
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Affiliation(s)
- Nazanin Ebrahimiadib
- Tehran University of Medical Sciences, Tehran, Iran.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | | | | | | | - Arash Maleki
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.,Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | | | - Amin Ahmadi
- Tehran University of Medical Sciences, Tehran, Iran
| | - Sydney Look-Why
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.,Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
| | - C Stephen Foster
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.,Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. COVID-19 and chronic kidney disease: a comprehensive review. J Bras Nefrol 2021; 43:383-399. [PMID: 33836039 PMCID: PMC8428633 DOI: 10.1590/2175-8239-jbn-2020-0203] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
Kidney impairment in hospitalized patients with SARS-CoV-2 infection is associated with increased in-hospital mortality and worse clinical evolution, raising concerns towards patients with chronic kidney disease (CKD). From a pathophysiological perspective, COVID-19 is characterized by an overproduction of inflammatory cytokines (IL-6, TNF-alpha), causing systemic inflammation and hypercoagulability, and multiple organ dysfunction syndrome. Emerging data postulate that CKD under conservative treatment or renal replacement therapy (RRT) is an important risk factor for disease severity and higher in-hospital mortality amongst patients with COVID-19. Regarding RAAS blockers therapy during the pandemic, the initial assumption of a potential increase and deleterious impact in infectivity, disease severity, and mortality was not evidenced in medical literature. Moreover, the challenge of implementing social distancing in patients requiring dialysis during the pandemic prompted national and international societies to publish recommendations regarding the adoption of safety measures to reduce transmission risk and optimize dialysis treatment during the COVID-19 pandemic. Current data convey that kidney transplant recipients are more vulnerable to more severe infection. Thus, we provide a comprehensive review of the clinical outcomes and prognosis of patients with CKD under conservative treatment and dialysis, and kidney transplant recipients and COVID-19 infection.
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Affiliation(s)
- Inah Maria D. Pecly
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Rafael B. Azevedo
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S. Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de Janeiro, Hospital Universitário
Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G. Botelho
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Gabriela G. Albuquerque
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Pedro Henrique P. Diniz
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Cibele I. S. Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências
Médicas e da Saúde, São Paulo, SP, Brasil
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Nopsopon T, Kittrakulrat J, Takkavatakarn K, Eiamsitrakoon T, Kanjanabuch T, Pongpirul K. Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009156. [PMID: 34129609 PMCID: PMC8232454 DOI: 10.1371/journal.pntd.0009156] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%. Conclusions This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths. Chronic kidney disease (CKD) was associated with increasing severity and mortality of COVID-19. End-stage renal disease (ESRD) patients were at the terminal stage of CKD and had reduced immune function due to uremia. Additionally, ESRD patients with kidney transplantation had a diminished immune system from immunosuppressive agents. Kidneys might be the secondary target of SARS-CoV-2 after the respiratory tract regardless of the previous history of kidney disease, preferably the glomerulus, which was associated with the richness of some specific protein-coding genes in the kidney. The overall pooled prevalence in ESRD patients with renal replacement therapy was approximately 22 times the referencing global average prevalence. The overall estimated case fatality rate of COVID-19 in ESRD patients with renal replacement therapy was approximately 3.6 times the global average. ESRD patients with renal replacement therapy had high COVID-19 prevalence and case fatality rate. We suggested that ESRD patients with renal replacement therapy should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.
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Affiliation(s)
- Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jathurong Kittrakulrat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanee Eiamsitrakoon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Bumrungrad International Hospital, Bangkok, Thailand
- * E-mail:
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Kobak S. The Perfect Storm: A Rheumatologist's Point of View on COVID-19 Infection. Curr Rheumatol Rev 2021; 17:141-152. [PMID: 33121412 DOI: 10.2174/1573397116666201029155105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
The new coronavirus infection (Covid-19) is a pandemic that has affected the whole world and progresses with high morbidity and mortality. It has a high contagion rate and a course capable of rapid lung involvement with severe acute respiratory distress syndrome (ARDS) and pulmonary insufficiency. A severe clinical picture develops as a result of a "perfect cytokine storm" which results from possible immunological mechanisms triggered by the viral infection. Immune system dysregulation and possible autoinflammatory and autoimmune mechanisms are responsible for a higher amount of cytokines release from immune cells. Although no clear treatment of Covid-19 infection has emerged yet, it is argued that some disease-modifying anti-rheumatic drugs (DMARDs) may be effective in addition to anti-viral treatments. These drugs (anti-malarial drugs, colchicum dispert, biologics) have been well known to rheumatologists for years because they are used in the treatment of many inflammatory rheumatologic diseases. Another important issue is whether DMARDs, which can cause severe immunosuppression, pose a risk for Covid-19 infection and whether they have been discontinued beforehand. Although there are insufficient data on this subject, considering the risk of disease reactivation, patients may continue their DMARDs treatment under the supervision of a rheumatologist. In this article, the possible immunological mechanisms in the pathogenesis of Covid-19 infection and the efficacy and safety of various DMARDs used in the treatment are discussed from a rheumatologist's perspective in the light of recent literature data.
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Affiliation(s)
- Senol Kobak
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Istinye University, Liv Hospital, Istanbul, Turkey
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