scholarly journals Coronavirus disease 2019 in solid organ transplant recipients in the setting of proactive screening and contact tracing of Qatar

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Rand A. Alattar ◽  
Shahd H. Shaar ◽  
Muftah Othman ◽  
Sulieman H. Abu Jarir ◽  
Samar M. Hashim ◽  
...  
Keyword(s):  
Clinical Data ◽  
Invasive Mechanical Ventilation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Contact Tracing ◽  
Solid Organ ◽  
Continuous Variables ◽  
Transplant Recipients ◽  
Presenting Symptoms ◽  
Asymptomatic Patients

Background: Clinical data on Coronavirus Disease 2019 (COVID-19) in solid organ transplant (SOT) recipients are limited. We herein report the initial clinical experience with COVID-19 in SOT recipients in Qatar. Methods: All SOT recipients with laboratory-confirmed COVID-19 up to May 23, 2020 were included. Demographic and clinical data were extracted retrospectively from the hospital’s electronic health records. Categorical data are presented as frequency and percentages, while continuous variables are summarized as medians and ranges. Results: Twenty-four SOT recipients with COVID-19 were identified (kidney 16, liver 6, heart 1, and liver and kidney 1). Organ transplantation preceded COVID-19 by a median of 60 months (range 1.7–184). The median age was 57 years (range 24–72), and 9 (37.5%) transplant recipients were females. Five (21%) asymptomatic patients were diagnosed through proactive screening. For the rest, fever (15/19) and cough (13/19) were the most frequent presenting symptoms. Five (20.8%) patients required invasive mechanical ventilation in the intensive care unit (ICU). Eleven (46%) patients developed acute kidney injury, including three in association with drug-drug interactions involving investigational COVID-19 therapies. Maintenance immunosuppressive therapy was modified in 18 (75%) patients, but systemic corticosteroids were not discontinued in any. After a median follow-up of 226 days (26–272), 20 (83.3%) patients had been discharged home, 2 (8.3%) were still hospitalized, 1 (4.2%) was still in the ICU, and 1 (4.2%) had died. Conclusions: Our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not uniformly worse than those in the general population. The results require confirmation in large, international cohorts.

scholarly journals Coronavirus disease 2019 in solid organ transplant recipients in a setting of proactive screening and contact tracing

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Rand A. Alattar ◽  
Shahd H. Shaar ◽  
Muftah Othman ◽  
Sulieman H. Abu Jarir ◽  
Samar M. Hashim ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Organ Transplant ◽  
Kidney Injury ◽  
Clinical Information ◽  
Solid Organ Transplant ◽  
Contact Tracing ◽  
Solid Organ ◽  
Continuous Variables ◽  
Presenting Symptoms ◽  
Liver And Kidney

Background: As of 26 June 2020, the global number of infections caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), had reached 11 million, with more than 500 thousand associated deaths. Limited clinical information about COVID-19 on solid organ transplant (SOT) are available so far. We herein report our preliminary experience with COVID-19 in SOT recipients in the first few weeks of the outbreak in Qatar. Method: All SOT recipients with laboratory-confirmed COVID-19 up to 23 May 2020 were included. Baseline characteristics, antivirals and immunosuppressive management, complications, and outcomes were retrospectively extracted from the electronic health system. Categorical data are summarized as frequency and percentages, while continuous variables are presented as medians and ranges. Results: Twenty-four SOT patients with COVID-19 were included in this report (kidney: 16, liver: 6, heart: 1, and combined liver and kidney: 1). The median age was 57 years (range 24–72). Thanks to proactive screening, five (21%) asymptomatic cases were diagnosed . Among the other 19 symptomatic patients, fever (15/19) and cough (13/19) were the most frequent presenting symptoms. All patients were hospitalized; 5 (21%) required invasive mechanical ventilation in the intensive care unit (ICU). Eleven (46%) patients developed acute kidney injury as a complication, including 3 in association with drug-drug interactions involving investigational COVID-19 therapies . Maintenance of immunosuppressive therapy was changed in 18 (75%) patients, but systemic corticosteroids were not withdrawn in any. After a median follow up of 43 days (26–89), 18 (75%) patients had been discharged home, 3 (12.3%) were still hospitalized, 2 (8.3%) were still in ICU, and 1 (4.2%) had died . Conclusion: Although higher mortality rates were observed in other reports, our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not consistently worse than other immunocompetent patients. The results require validation in larger cohorts.

scholarly journals 929. Recurrent Nocardiosis in Solid Organ Transplant Recipients: An Evaluation of Post-Treatment Prophylaxis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S556-S557
Author(s):  
Zachary A Yetmar ◽  
John Wilson ◽  
Elena Beam
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Post Treatment ◽  
Solid Organ ◽  
Continuous Variables ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Abstract Background Nocardia more commonly causes infection in immunocompromised individuals, notably with a relapse rate of approximately 5%. Solid organ transplant recipients will often receive post-treatment prophylaxis as the underlying immunosuppression is unable to be completely removed. However, data supporting this practice is sparse. We sought to evaluate recurrence of nocardiosis in solid organ transplant recipients, specifically evaluating the role of post-treatment prophylaxis. Methods We conducted a retrospective cohort study of solid organ transplant (SOT) recipients at our medical center diagnosed with nocardiosis from 2000 through 2020. We included adult SOT recipients who completed their course of Nocardia therapy. Patients were excluded if they had not yet completed therapy, died prior to completing therapy, or there was no post-therapy follow-up. The primary outcome was Nocardia recurrence. Continuous variables were presented as mean or median with interquartile range (IQR). Results 108 patients meeting inclusion criteria were analyzed. 72 (66.7%) were male and median age was 60 years (IQR 52-65). Most common SOT types were kidney (47.2%), heart (17.6%), kidney-pancreas (11.1%), and lung (11.1%). Median time from transplantation to diagnosis of nocardiosis was 396 days (IQR 154-1071). Most common sites of infection were lung (88.0%), skin (16.7%), brain (13.9%), and blood (6.5%). Multi-organ infection was present in 22.2% and 24.1% were on trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at diagnosis. Post-treatment prophylaxis was utilized in 55 (50.9%) patients (Table 1). TMP-SMX was the most common prophylaxis (87.3%; Figure 1). Four patients experienced Nocardia recurrence, 2 of which were receiving TMP-SMX prophylaxis at time of relapse (Table 2). These were dosed as double strength tablet daily and weekly, respectively. Median time from treatment completion to relapse was 255.5 days (range 107-871). Figure 1. Post-Treatment Prophylaxis Regimens for Nocardia in 55 Patients Conclusion Nocardia recurrence in solid organ transplant recipients is an uncommon occurrence. Double strength daily and weekly TMP-SMX prophylaxis does not appear to be entirely protective and relapse may be dependent upon other factors such as primary treatment length. Further study into the use of post-treatment prophylaxis is warranted. Disclosures All Authors: No reported disclosures

Cytomegalovirus in Solid Organ Transplant Recipients: Clinical Updates, Challenges and Future Directions

2020 ◽  
Vol 26 (28) ◽  
pp. 3497-3506
Author(s):  
Raymund R. Razonable
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Future Directions ◽  
Prevention And Treatment ◽  
Solid Organ Transplant Recipients

Cytomegalovirus is the classic opportunistic infection after solid organ transplantation. This review will discuss updates and future directions in the diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention, but they should not be mutually exclusive and each strategy should be considered depending on a specific situation. The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is emphasized as a major factor that should pave the way for an individualized approach to prevention. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management, and strategies for managing drug-resistant CMV infection are enumerated. There is increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, and their potential role in optimizing CMV prevention and treatment efforts is discussed.

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