COVID-19 in solid organ transplant recipients: Initial report from the US epicenter

Am J Transplant. 2020 Jul;20(7):1800-1808. doi: 10.1111/ajt.15941. Epub 2020 May 10.

Abstract

Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.

Keywords: antibiotic: antiviral; clinical research/practice; complication: infectious; immunosuppression/immune modulation; infection and infectious agents - viral; infectious disease; organ transplantation in general.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Adult
  • Aged
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antiviral Agents / therapeutic use
  • Azithromycin / therapeutic use
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality
  • Critical Care
  • Female
  • Hospitalization
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunosuppression
  • Immunosuppressive Agents / therapeutic use
  • Intensive Care Units
  • Intubation
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Organ Transplantation / adverse effects*
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / mortality
  • Respiration, Artificial
  • SARS-CoV-2
  • Steroids / therapeutic use
  • Transplant Recipients*
  • Treatment Outcome
  • United States

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Immunosuppressive Agents
  • Steroids
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • Azithromycin
  • tocilizumab
  • Alanine

Supplementary concepts

  • COVID-19 drug treatment