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 journalArticlepeer-review

400 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 languageEnglish (US)
Pages (from-to)1800-1808
Number of pages9
JournalAmerican Journal of Transplantation
Volume20
Issue number7
DOIs
StatePublished - Jul 1 2020
Externally publishedYes

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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