tetano
Editor, Senior Moderator
Kidney Med
. 2020 Jun 15;2(4):459-466.
doi: 10.1016/j.xkme.2020.06.001. eCollection Jul-Aug 2020.
COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Case Series of 22 Cases From Belgium
Arnaud Devresse[SUP] 1 [/SUP], Leila Belkhir[SUP] 2 [/SUP], Bernard Vo[SUP] 1 [/SUP], Benoit Ghaye[SUP] 3 [/SUP], Ana?s Scohy[SUP] 4 [/SUP], Benoit Kabamba[SUP] 4 [/SUP], Eric Goffin[SUP] 1 [/SUP], Julien De Greef[SUP] 2 [/SUP], Michel Mourad[SUP] 5 [/SUP], Martine De Meyer[SUP] 5 [/SUP], Jean-Cyr Yombi[SUP] 4 [/SUP], Nada Kanaan[SUP] 1 [/SUP]
Affiliations
Abstract
Rationale & objective: The world is facing a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although kidney transplant recipients are at increased risk for viral infections, the impact of their chronic immunosuppressed status on the risk for acquiring coronavirus disease 2019 (COVID-19) and disease severity is unknown.
Study design: All cases of COVID-19 infection in our cohort of kidney transplant recipients were prospectively monitored. Clinical features, management, and outcomes were recorded. A standard strategy of immunosuppression minimization was applied: discontinue the antimetabolite drug and reduce trough levels of calcineurin or mammalian target of rapamycin inhibitors. Unless contraindicated, hydroxychloroquine was administered only to hospitalized patients.
Setting & participants: 22 COVID-19 infections were diagnosed in our cohort of 1,200 kidney transplant recipients.
Results: Most common initial symptoms included fever, cough, or dyspnea. 18 (82%) patients required hospitalization. Of those patients, 3 had everolimus-based immunosuppression. Computed tomography of the chest at admission (performed in 15 patients) showed mild (n = 3), moderate (n = 8), extensive (n = 1), severe (n = 2), and critical (n = 1) involvement. Immunosuppression reduction was initiated in all patients. Hydroxychloroquine was administered to 15 patients. 11 patients required supplemental oxygen; 2 of them were admitted to an intensive care unit (ICU) with mechanical ventilation. After a median of 10 days, 13 kidney transplant recipients were discharged, 2 were hospitalized in non-ICU units, 1 was in the ICU, and 2 patients had died.
Limitations: Small sample size and short follow-up.
Conclusions: The clinical presentation of COVID-19 infection was similar to that reported in the general population. A standard strategy of immunosuppression minimization and treatment was applied, with 11% mortality among kidney transplant recipients hospitalized with COVID-19 infection.
Keywords: COVID-19; Sars-CoV-2 virus; coronavirus disease 2019; immunosuppression; kidney transplantation; outcomes.
. 2020 Jun 15;2(4):459-466.
doi: 10.1016/j.xkme.2020.06.001. eCollection Jul-Aug 2020.
COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Case Series of 22 Cases From Belgium
Arnaud Devresse[SUP] 1 [/SUP], Leila Belkhir[SUP] 2 [/SUP], Bernard Vo[SUP] 1 [/SUP], Benoit Ghaye[SUP] 3 [/SUP], Ana?s Scohy[SUP] 4 [/SUP], Benoit Kabamba[SUP] 4 [/SUP], Eric Goffin[SUP] 1 [/SUP], Julien De Greef[SUP] 2 [/SUP], Michel Mourad[SUP] 5 [/SUP], Martine De Meyer[SUP] 5 [/SUP], Jean-Cyr Yombi[SUP] 4 [/SUP], Nada Kanaan[SUP] 1 [/SUP]
Affiliations
- PMID: 32775986
- PMCID: PMC7295531
- DOI: 10.1016/j.xkme.2020.06.001
Abstract
Rationale & objective: The world is facing a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although kidney transplant recipients are at increased risk for viral infections, the impact of their chronic immunosuppressed status on the risk for acquiring coronavirus disease 2019 (COVID-19) and disease severity is unknown.
Study design: All cases of COVID-19 infection in our cohort of kidney transplant recipients were prospectively monitored. Clinical features, management, and outcomes were recorded. A standard strategy of immunosuppression minimization was applied: discontinue the antimetabolite drug and reduce trough levels of calcineurin or mammalian target of rapamycin inhibitors. Unless contraindicated, hydroxychloroquine was administered only to hospitalized patients.
Setting & participants: 22 COVID-19 infections were diagnosed in our cohort of 1,200 kidney transplant recipients.
Results: Most common initial symptoms included fever, cough, or dyspnea. 18 (82%) patients required hospitalization. Of those patients, 3 had everolimus-based immunosuppression. Computed tomography of the chest at admission (performed in 15 patients) showed mild (n = 3), moderate (n = 8), extensive (n = 1), severe (n = 2), and critical (n = 1) involvement. Immunosuppression reduction was initiated in all patients. Hydroxychloroquine was administered to 15 patients. 11 patients required supplemental oxygen; 2 of them were admitted to an intensive care unit (ICU) with mechanical ventilation. After a median of 10 days, 13 kidney transplant recipients were discharged, 2 were hospitalized in non-ICU units, 1 was in the ICU, and 2 patients had died.
Limitations: Small sample size and short follow-up.
Conclusions: The clinical presentation of COVID-19 infection was similar to that reported in the general population. A standard strategy of immunosuppression minimization and treatment was applied, with 11% mortality among kidney transplant recipients hospitalized with COVID-19 infection.
Keywords: COVID-19; Sars-CoV-2 virus; coronavirus disease 2019; immunosuppression; kidney transplantation; outcomes.