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Am J Transplant. 2020 Apr 16. doi: 10.1111/ajt.15929. [Epub ahead of print]
COVID-19 in solid organ transplant recipients: a single-center case series from Spain.
Fern?ndez-Ruiz M1, Andr?s A2, Loinaz C3, Delgado JF4,5, L?pez-Medrano F1, San Juan R1, Gonz?lez E2, Polanco N2, Folgueira MD6, Lalueza A7, Lumbreras C7, Aguado JM1.
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Abstract
The clinical characteristics, management and outcome of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after solid organ transplantation (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%] and heart [22.2%]) recipients diagnosed with COVID-19 by March 23, 2020 at a tertiary-care center at Madrid. Median age at diagnosis was 71.0 ? 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine [HCQ]) was used in 50.0% of patients, and had to be prematurely discontinued in two of them. Other antiviral regimens included HCQ monotherapy (27.8%) and interferon-β (16.7%). As of April 4, the case fatality rate was 27.8% (5/18). After a median follow-up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C reactive protein levels at various points were significantly higher among recipients that experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS-CoV-2 infection has a severe course in SOT recipients.
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KEYWORDS:
COVID-19; SARS-CoV-2; coronavirus; outcome; solid organ transplantation; treatment
PMID:32301155DOI:10.1111/ajt.15929