COVID-19 in solid organ transplant recipients: a single-center experience

Transpl Int. 2020 Sep;33(9):1099-1105. doi: 10.1111/tri.13662. Epub 2020 Jun 26.

Abstract

Solid organ transplant (SOT) recipients may be at risk for severe COVID-19. Data on the clinical course of COVID-19 in immunosuppressed patients are limited, and the effective treatment strategy for these patients is unknown. We describe our institutional experience with COVID-19 in SOT. Demographic, clinical, and treatment data were extracted from the electronic patient files. A total of 23 SOT transplant recipients suffering from COVID-19 were identified (n = 3 heart; n = 15 kidney; n = 1 kidney-after-heart; n = 3 lung, and n = 1 liver transplant recipient). The presenting symptoms were similar to nonimmunocompromised patients. Eighty-three percent (19/23) of the patients required hospitalization, but only two of these were transferred to the intensive care unit. Five patients died from COVID-19; all had high Clinical Frailty Scores. In four of these patients, mechanical ventilation was deemed futile. In 57% of patients, the immunosuppressive therapy was not changed and only three patients were treated with chloroquine. Most patients recovered without experimental antiviral therapy. Modification of the immunosuppressive regimen alone could be a therapeutic option for SOT recipients suffering from moderate to severe COVID-19. Pre-existent frailty is associated with death from COVID-19.

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • COVID-19 / immunology
  • COVID-19 / therapy
  • Female
  • Humans
  • Immunosuppression / adverse effects*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Organ Transplantation / adverse effects*
  • Pandemics
  • SARS-CoV-2
  • Transplant Recipients*
  • Treatment Outcome
  • Young Adult