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

Marcus R. Pereira; Sumit Mohan; David J. Cohen; Syed A. Husain; Geoffrey K. Dube; Lloyd E. Ratner; Selim Arcasoy; Meghan M. Aversa; Luke J. Benvenuto; Darshana M. Dadhania; Sandip Kapur; Lorna M. Dove; Robert S. Brown; Russell E. Rosenblatt; Benjamin Samstein; Nir Uriel; Maryjane A. Farr; Michael Satlin; Catherine B. Small; Thomas J. Walsh; Rosy P. Kodiyanplakkal; Benjamin A. Miko; Justin G. Aaron; Demetra S. Tsapepas; Jean C. Emond; Elizabeth C. Verna

doi:10.1111/ajt.15941

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

Marcus R. Pereira, Sumit Mohan, David J. Cohen, Syed A. Husain, Geoffrey K. Dube, Lloyd E. Ratner, Selim Arcasoy, Meghan M. Aversa, Luke J. Benvenuto, Darshana M. Dadhania, Sandip Kapur, Lorna M. Dove, Robert S. Brown, Russell E. Rosenblatt, Benjamin Samstein, Nir Uriel, Maryjane A. Farr, Michael Satlin, Catherine B. Small, Thomas J. WalshRosy P. Kodiyanplakkal, Benjamin A. Miko, Justin G. Aaron, Demetra S. Tsapepas, Jean C. Emond, Elizabeth C. Verna

Research output: Contribution to journal › Article › peer-review

629 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1800-1808
Number of pages	9
Journal	American Journal of Transplantation
Volume	20
Issue number	7
DOIs	https://doi.org/10.1111/ajt.15941
State	Published - Jul 1 2020
Externally published	Yes

Keywords

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

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1111/ajt.15941

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Pereira, M. R., Mohan, S., Cohen, D. J., Husain, S. A., Dube, G. K., Ratner, L. E., Arcasoy, S., Aversa, M. M., Benvenuto, L. J., Dadhania, D. M., Kapur, S., Dove, L. M., Brown, R. S., Rosenblatt, R. E., Samstein, B., Uriel, N., Farr, M. A., Satlin, M., Small, C. B., ... Verna, E. C. (2020). COVID-19 in solid organ transplant recipients: Initial report from the US epicenter. American Journal of Transplantation, 20(7), 1800-1808. https://doi.org/10.1111/ajt.15941

Pereira, MR, Mohan, S, Cohen, DJ, Husain, SA, Dube, GK, Ratner, LE, Arcasoy, S, Aversa, MM, Benvenuto, LJ, Dadhania, DM, Kapur, S, Dove, LM, Brown, RS, Rosenblatt, RE, Samstein, B, Uriel, N, Farr, MA, Satlin, M, Small, CB, Walsh, TJ, Kodiyanplakkal, RP, Miko, BA, Aaron, JG, Tsapepas, DS, Emond, JC & Verna, EC 2020, 'COVID-19 in solid organ transplant recipients: Initial report from the US epicenter', American Journal of Transplantation, vol. 20, no. 7, pp. 1800-1808. https://doi.org/10.1111/ajt.15941

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title = "COVID-19 in solid organ transplant recipients: Initial report from the US epicenter",

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",

author = "Pereira, {Marcus R.} and Sumit Mohan and Cohen, {David J.} and Husain, {Syed A.} and Dube, {Geoffrey K.} and Ratner, {Lloyd E.} and Selim Arcasoy and Aversa, {Meghan M.} and Benvenuto, {Luke J.} and Dadhania, {Darshana M.} and Sandip Kapur and Dove, {Lorna M.} and Brown, {Robert S.} and Rosenblatt, {Russell E.} and Benjamin Samstein and Nir Uriel and Farr, {Maryjane A.} and Michael Satlin and Small, {Catherine B.} and Walsh, {Thomas J.} and Kodiyanplakkal, {Rosy P.} and Miko, {Benjamin A.} and Aaron, {Justin G.} and Tsapepas, {Demetra S.} and Emond, {Jean C.} and Verna, {Elizabeth C.}",

note = "Publisher Copyright: {\textcopyright} 2020 The American Society of Transplantation and the American Society of Transplant Surgeons",

year = "2020",

month = jul,

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doi = "10.1111/ajt.15941",

language = "English (US)",

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T1 - COVID-19 in solid organ transplant recipients

T2 - Initial report from the US epicenter

AU - Pereira, Marcus R.

AU - Mohan, Sumit

AU - Cohen, David J.

AU - Husain, Syed A.

AU - Dube, Geoffrey K.

AU - Ratner, Lloyd E.

AU - Arcasoy, Selim

AU - Aversa, Meghan M.

AU - Benvenuto, Luke J.

AU - Dadhania, Darshana M.

AU - Kapur, Sandip

AU - Dove, Lorna M.

AU - Brown, Robert S.

AU - Rosenblatt, Russell E.

AU - Samstein, Benjamin

AU - Uriel, Nir

AU - Farr, Maryjane A.

AU - Satlin, Michael

AU - Small, Catherine B.

AU - Walsh, Thomas J.

AU - Kodiyanplakkal, Rosy P.

AU - Miko, Benjamin A.

AU - Aaron, Justin G.

AU - Tsapepas, Demetra S.

AU - Emond, Jean C.

AU - Verna, Elizabeth C.

PY - 2020/7/1

Y1 - 2020/7/1

N2 - 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.

AB - 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.

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KW - immunosuppression/immune modulation

KW - infection and infectious agents – viral

KW - infectious disease

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

Abstract

Keywords

ASJC Scopus subject areas

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