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

Am J Transplant. 2020 Jul;20(7):1849-1858. doi: 10.1111/ajt.15929. Epub 2020 May 10.

Abstract

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

Keywords: COVID-19; SARS-CoV-2; coronavirus; outcome; solid organ transplantation; treatment.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiviral Agents / administration & dosage
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy*
  • Drug Combinations
  • Female
  • Fever
  • Humans
  • Hydroxychloroquine / administration & dosage
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Interferon-beta / administration & dosage
  • Lopinavir / administration & dosage
  • Male
  • Middle Aged
  • Organ Transplantation*
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy*
  • Radiography, Thoracic
  • Retrospective Studies
  • Ritonavir / administration & dosage
  • SARS-CoV-2
  • Spain / epidemiology
  • Transplant Recipients*

Substances

  • Antiviral Agents
  • Drug Combinations
  • Immunosuppressive Agents
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • Hydroxychloroquine
  • Interferon-beta
  • Ritonavir