scholarly journals Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand?

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Farbod Shahabinezhad ◽  
Tahmoores Niknam ◽  
Seyed Ahmad Tara ◽  
Elham Haem ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Clinical Complications ◽  
Hospitalization Period ◽  
Significant Difference ◽  
Immunocompromised Status ◽  
Immunomodulatory Drug

Abstract Background The management of COVID-19 in organ transplant recipients is among the most imperative, yet less discussed, issues based on their immunocompromised status along with their vast post-transplant medication regimens. No conclusive study has been published to evaluate proper anti-viral and immunomodulator medications effect in treating COVID-19 patients to this date. Method This retrospective study was conducted in Shiraz Transplant Hospital, Iran from March 2020 to May 2021 and included COVID-19 diagnosed patients based on SARS-CoV-2 RT-PCR positive test who had been hospitalized for at least 48 h before enrolling in the study. Clinical and demographic information of patients, along with their treatment course and the medication used were evaluated and analyzed using multiple regression analysis. Results A total of 245 patients with a mean age of 49.59 years were included with a mortality rate of 8.16%. The administration of Remdesivir as an anti-viral drug (P value < 0.001) and Tocilizumab as an immunomodulator drug (P value < 0.001) could reduce the hospitalization period in the hospital and the intensive care unit, as well as the mortality rates significantly. Meanwhile, the patients treated with Lopinavir/Ritonavir experienced a lower chance of survival (OR < 1, P value = 0.04). No significant difference was observed between various therapeutic regimens in clinical complications such as bacterial coinfections, cardiovascular and gastrointestinal adverse reactions, and liver or kidney dysfunctions. Conclusion The administration of Remdesivir as an anti-viral and Tocilizumab as an immunomodulatory drug in solid-organ transplant recipients could be promising treatments of choice to manage COVID-19.

scholarly journals Evaluation of The Therapeutic Regimen in COVID-19 in Transplant Patients: Where Do Immunomodulatory and Antivirals Stand?

2021 ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Farbod Shahabinezhad ◽  
Tahmoores Niknam ◽  
Seyed Ahmad Tara ◽  
Elham Haem ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Organ Transplant ◽  
P Value ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Clinical Complications ◽  
Hospitalization Period ◽  
Significant Difference ◽  
Immunocompromised Status ◽  
Immunomodulatory Drug

Abstract Background The management of COVID-19 in organ transplant recipients is among the most imperative, yet less discussed, issues based on their immunocompromised status along with their vast post-transplant medication regimens. No conclusive study has been published to evaluate proper anti-viral and immunomodulator medications effect in treating COVID-19 patients to this date. Method: This retrospective study was conducted in Shiraz Transplant Hospital, Iran from March 2020 to May 2021 and included COVID-19 diagnosed patients based on SARS-CoV-2 RT-PCR positive test who had been hospitalized for at least 48 hours before enrolling in the study. Clinical and demographic information of patients, along with their treatment course and the medication used were evaluated and analyzed using multiple regression analysis. Results A total of 245 patients with a mean age of 49.59 years were included with a mortality rate of 8.16%. The administration of Remdesivir as an anti-viral drug (P-value˂0.001) and Tocilizumab as an immunomodulator drug (P-value < 0.001) could reduce the hospitalization period in the hospital and the intensive care unit, as well as the mortality rates significantly. Meanwhile, the patients treated with Lopinavir/Ritonavir experienced a lower chance of survival (OR < 1, P-value = 0.04). No significant difference was observed between various therapeutic regimens in clinical complications such as bacterial coinfections, cardiovascular and gastrointestinal adverse reactions, and liver or kidney dysfunctions. Conclusion The administration of Remdesivir as an anti-viral and Tocilizumab as an immunomodulatory drug in SOT recipients could be promising treatments of choice to manage COVID-19.

scholarly journals Improving Transplant Medication Safety Through a Technology and Pharmacist Intervention (ISTEP): Protocol for a Cluster Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Casey L Hall ◽  
Cory E Fominaya ◽  
Mulugeta Gebregziabher ◽  
Sherry K Milfred-LaForest ◽  
Kelsey M Rife ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medication Safety ◽  
Organ Transplant ◽  
Pharmacist Intervention ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Randomized Controlled ◽  
Transplant Patients ◽  
Cluster Randomized

BACKGROUND Medication errors, adverse drug events, and nonadherence lead to increased health care utilization and increased risk of adverse clinical outcomes, including graft loss, in solid organ transplant recipients. Veterans living with organ transplants represent a population that is at substantial risk for medication safety events and fragmented care coordination issues. To improve medication safety and long-term clinical outcomes in veteran transplant patients, interventions should address interorganizational system failures and provider-level and patient-level factors. OBJECTIVE This study aims to measure the clinical and economic effectiveness of a pharmacist-led, technology-enabled intervention, compared with usual care, in veteran organ transplant recipients. METHODS This is a 24-month prospective, parallel-arm, cluster-randomized, controlled multicenter study. The pharmacist-led intervention uses an innovative dashboard system to improve medication safety and health outcomes, compared with usual posttransplant care. Pharmacists at 10 study sites will be consented into this study before undergoing randomization, and 5 sites will then be randomized to each study arm. Approximately, 1600 veteran transplant patients will be included in the assessment of the primary outcome across the 10 sites. RESULTS This study is ongoing. Institutional review board approval was received in October 2018 and the study opened in March 2019. To date there are no findings from this study, as the delivery of the intervention is scheduled to occur over a 24-month period. The first results are expected to be submitted for publication in August 2021. CONCLUSIONS With this report, we describe the study design, methods, and outcome measures that will be used in this ongoing clinical trial. Successful completion of the Improving Transplant Medication Safety through a Technology and Pharmacist Intervention study will provide empirical evidence of the effectiveness of a feasible and scalable technology-enabled intervention on improving medication safety and costs.

Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

2021 ◽  
Vol 15 (5) ◽  
pp. 1064-1067
Author(s):  
M Asim Rana ◽  
M Ahad Qayyum ◽  
Amer Latif ◽  
M Afzal Bhatti ◽  
Syed Arsalan Khalid ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Interquartile Range ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Solid Organ Transplant Recipients ◽  
Overall Mortality

Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center. Keywords: Incidence, Outcome, COVID-19, Infection

scholarly journals Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

2018 ◽  
Vol 33 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Sharon Tzelnick ◽  
Ethan Soudry
Keyword(s):  
Survival Rates ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Sinus Surgery ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Solid Organ Transplant Recipients ◽  
Lung Transplant Recipients

Introduction Survival rates of solid organ transplant recipients are steadily increasing. Chronic immunosuppression is a key to sustain the transplanted organ. Thus, these patients are at a higher risk for fulminant disease and severe complications of rhinosinusitis (RS). Surprisingly, this has been scarcely discussed in the literature. Objective To analyze the characteristics and disease course of RS in solid organ transplant recipients. Materials and Methods Retrospective study. Medical records of all solid organ transplant recipients with a diagnosis RS treated at a national transplant center between the years 2001 and 2016 were reviewed. Results Of 4562 solid organ transplant recipients, a documented diagnosis of RS was identified only in 61 (1.3%) patients. Sixty-four patients presented with posttransplantation RS; of them, 54.5% had chronic RS (CRS) and the remaining 45.5% patients were diagnosed with acute RS. Microbial cultures grew almost exclusively bacterial pathogens. A documented invasive fungal infection was noted in only 2 patients. A total of 24 (40%) patients underwent endoscopic sinus surgery, the majority (22) for CRS. On subgroup analysis, surgical intervention was more frequent in lung transplant recipients ( P = .005). Neither specific disease nor surgical complications were found. Conclusions Interestingly, acute fulminant infection or sinusitis complications in solid organ transplant patients were much lower than expected. CRS in this patient group was less frequent than expected as well. Whether chronic immunosuppression minimizes the likelihood for CRS deserves further investigation. A more surgically oriented approach in CRS patients may be favored early in the management course of medically refractory patients in light of patients excellent outcomes.

scholarly journals Predicting factors leading to cardiac arrest in solid organ transplant recipients: a retrospective analysis of code blue patients

2018 ◽  
Vol 8 (1) ◽  
pp. 62-67
Author(s):  
Subhash P. Acharya ◽  
Laura Hawryluck ◽  
Stuart McCluskey ◽  
Andrew Steel
Keyword(s):  
Serum Magnesium ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Warning Signs ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Code Blue ◽  
Solid Organ Transplant Recipients

Background: Cardio Pulmonary (Code Blue) arrests in solid organ transplant recipients are particularly distressing events in view of the tremendous investment by organ donors, families, and by the healthcare system. Methods: After ethical approval, all code blue events occurring in solid organ transplant patients were identified from Critical Care Response Team (CCRT) database and the code blue resuscitation records from 2007-2011. All patients who sustained cardio-respiratory arrests were included. Resuscitation records were also explored to identify quality, duration and immediate event and outcome. Results: Over the five-year period, there were 63 code blue calls in solid organ transplant patients out of which only 27 (n=27) were actual code blue arrest requiring resuscitation. The frequency was highest in liver transplant (10), followed by lungs (8), kidney (5), double organ (kidney + liver/lung = 2), and heart (1), and one patient with Liver transplantation had arrested twice. Seventeen (62.96%) of these patients were in the ward while 10 (37.04%) were in the step-down unit (SDU) when the arrest occurred. Most of them (16, 59.25%) were attended by a nurse within 30-mins prior to the code. Factors associated in these code blue patients were documented source of infection (11, 40.74%), blood transfusion (7, 23.9%), surgical event as cause of arrest (6, 22.22%), procedures within 24 hours (6, 22.22%) and dialysis within 24 hours (5, 18.51%). It was also found that serum magnesium was low on almost all patients. Conclusion: Even though the frequency of code blue events in solid organ transplant patients was not high, it was concerning that in many events with prior warning signs of deterioration did not result in CCRT being called. However resuscitations were prolonged reflecting the teams’ investment in this patient population. This study thus highlights the importance of early involvement of CCRT in these patients.

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