scholarly journals Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients

2020 ◽  
Vol 78 (2) ◽  
pp. 281-286 ◽  
Author(s):  
Alireza Abrishami ◽  
Shiva Samavat ◽  
Behdad Behnam ◽  
Mehran Arab-Ahmadi ◽  
Mohsen Nafar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Course ◽  
Imaging Features ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals 530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S332-S332
Author(s):  
Anna Hardesty ◽  
Aakriti Pandita ◽  
Yiyun Shi ◽  
Kendra Vieira ◽  
Ralph Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Case Control Study ◽  
Clinical Course ◽  
Case Series ◽  
Case Fatality ◽  
Case Control ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: review of 1589 patients

2018 ◽  
Vol 275 (5) ◽  
pp. 1183-1188 ◽  
Author(s):  
Gwanghui Ryu ◽  
Min Young Seo ◽  
Kyung Eun Lee ◽  
Hyo Yeol Kim ◽  
Hun-Jong Dhong ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Course ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Herpes Zoster in Kidney Transplant Recipients: A Series of Three Cases

2020 ◽  
Vol 10 (3) ◽  
pp. 139-146 ◽  
Author(s):  
Ramy M. Hanna ◽  
Farid Abd-El-Malak ◽  
Ammar Alnaser ◽  
Rumi Cader ◽  
Julie M. Yabu
Keyword(s):  
Herpes Zoster ◽  
Kidney Transplant ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Varicella Zoster ◽  
Organ Rejection ◽  
Increased Risk ◽  
Disseminated Disease

Kidney transplant recipients require lifelong immunosuppression to prevent organ rejection. The need for this intervention, however, leads to decreased cellular immunity and, in turn, increased risk of developing herpes zoster (HZ) from reactivation of latent varicella zoster virus. HZ commonly presents as a painful rash in a dermatome presentation followed by post-herpetic neuralgia. In immunosuppressed individuals, the presentation can be atypical and vary in severity depending on degree of immunosuppression and host immune response. We present the clinical course of 3 kidney transplant recipients who developed HZ after transplantation at different times post-transplant with varying clinical manifestations. The balance between maintaining immunosuppression and preventing or subsequently treating disseminated disease is discussed.

scholarly journals SP750RENAL CELL CARCINOMA IN KIDNEY TRANSPLANT RECIPIENTS - INCIDENCE RATES AND CLINICAL COURSE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii396-iii396
Author(s):  
Hendrik Eggers ◽  
Ulrike Ehlers ◽  
Anke Schwarz ◽  
Hermann Haller ◽  
Viktor Gruenwald ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Kidney Transplant ◽  
Clinical Course ◽  
Incidence Rates ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Kidney Allograft Recipients Diagnosed with Coronavirus Disease-2019: A Single Center Report

2020 ◽  
Author(s):  
Michelle Lubetzky ◽  
Meredith Aull ◽  
Rebecca Craig-Schapiro ◽  
Jun B. Lee ◽  
John R. Lee ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Bacterial Infections ◽  
Case Fatality Rate ◽  
Clinical Course ◽  
Case Fatality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

AbstractBackgroundOrgan graft recipients receiving immunosuppressive therapy are likely to be at heightened risk for the Coronavirus Disease 2019 (Covid-19) and adverse outcomes including death. It is therefore important to characterize the clinical course and outcome of Covid-19 in this vulnerable population and identify therapeutic strategies that are safe.MethodsWe performed a retrospective chart review of 54 adult kidney transplant patients diagnosed with Covid-19 and all managed in New York State, the epicenter of Covid-19 pandemic. All 54 patients were evaluated by video visits, or phone interviews, and referred to our Fever Clinic or Emergency Room for respiratory illness symptoms consistent with Covid-19 and admitted if deemed necessary from March 13, 2020 to April 20, 2020. Characteristics of the patients were stratified by hospitalization status and disease severity. Clinical course including alterations in immunosuppressive therapy were retrieved from their electronic medical records. Primary outcomes included recovery from Covid-19 symptoms, acute kidney injury, graft failure, and case fatality rate.ResultsOf the 54 SARS-Cov-2 positive kidney transplant recipients, 39 with moderate to severe symptoms were admitted and 15 with mild symptoms were managed at home. Hospitalized patients compared to non-hospitalized patients were more likely to be male, of Hispanic ethnicity, and to have cardiovascular disease. At baseline, all but 2 were receiving tacrolimus, mycophenolate mofetil (MMF) and 32 were on a steroid free immunosuppression regimen. Tacrolimus dosage was reduced in 46% of hospitalized patients and maintained at baseline level in the non-hospitalized cohort. Mycophenolate mofetil (MMF) dosage was maintained at the baseline dosage in 11% of hospitalized patients and 64% of non-hospitalized patients and was stopped in 61% hospitalized patients and 0% in the non-hospitalized cohort. Azithromycin or doxycycline were prescribed at a similar rate among hospitalized and non-hospitalized patients (38% vs. 40%). In addition, 50% of hospitalized patients were treated for concurrent bacterial infections including pneumonia, urinary tract infections and sepsis. Hydroxychloroquine was prescribed in 79% of hospitalized patients and only one of 15 non-hospitalized patients. Acute kidney injury occurred in 51% of hospitalized patients. Patients with severe disease were more likely to have elevations in inflammatory biomarkers at presentation. At a median of 21 days follow up, 67% of patients have had their symptoms resolved or improved and 33% have persistent symptoms. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%). Three of 39 (8%) hospitalized patients expired and none of the 15 non-hospitalized patients expired.ConclusionsClinical presentation of Covid-19 in kidney transplant recipients was similar to what has been described in the general population. The case fatality rate in our entire cohort of 54 kidney transplant recipients was reassuringly low and patients with mild symptomology could be successfully managed at home. Data from the our study suggest that a strategy of systematic screening and triage to outpatient or inpatient care, close monitoring, early management of concurrent bacterial infections and judicious use of immunosuppressive drugs rather than cessation is beneficial.

scholarly journals Favorable Outcome of COVID-19 Pneumonia in a Kidney Transplant Recipient Treated with Tocilizumab

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Adnane Guella ◽  
Osman Elfadil ◽  
Ghisson Abdulrazaq ◽  
Sahla Osman ◽  
Mohammed Munir Khan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Patient ◽  
Clinical Course ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Immunosuppressive Medications ◽  
Therapeutic Guidelines ◽  
The Subject

The presentation of COVID-19 pneumonia in kidney transplant recipients is similar to that of the general population. However, in the former, it may have a worse clinical course. We report a kidney transplant patient affected by COVID-19 pneumonia whose condition worsened 9 days after the initial presentation. As no therapeutic guidelines on the subject are currently available, here we share our approach in the management of the immunosuppressive medications and the antiviral therapy and compare them to the scarce available data. We also expose the use of tocilizumab in our patient with excellent results.

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