Dr. Jeremy R. Chapman, Editor-in-Chief, Transplantation

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

Kataria A, Yakubu I, Winstead R
Transplantation Direct: August 2020 - Volume 6 - Issue 8 - p e582

SARSCOV2 and the disease it has spawned COVID-19 – where have we go to so far? Time for round up of what we know and what we don’t in one easy to read paper. Kidney transplant recipients seem to be at increased risk of serious complications from COVID-19 compared to the general population both because of their immunosuppressed state and their prevalence of comorbidities like diabetes, heart disease, and lung disease. The data suggests that mortality on dialysis may well be comparable to kidney transplants which has changed the risk balance towards transplantation from the very early days of the pandemic. This concise review provides state of play epidemiology in kidney transplant recipients, manifestations, management, and clinical outcomes based on the available literature. Specific antiviral measures against COVID-19 have not shown a clear-cut benefit in smaller studies though we await results of several ongoing larger clinical trials. COVID-19 has of course impacted on broad kidney transplant center practice and volumes, donation, recipient care, induction immunosuppression and surgical strategies. Worth a read for all of us managing in this new world order.

CLICK HERE TO VIEW

CLICK HERE TO VIEW (OPEN ACCESS)

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19

Adarsh Bhimraj et al.
Clin Infect Dis 2020 Apr 27;ciaa478. doi: 10.1093/cid/ciaa478.

The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations. The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.

COVID-19 Infection in Kidney Transplant Recipients: Disease Incidence and Clinical Outcomes

Michelle Elias et al.
JASN August 2020, ASN.2020050639; DOI: https://doi.org/10.1681/ASN.2020050639

Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19–positive patients. Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease.

Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States

Michael W Fried et al.
Clin Infect Dis 2020 Aug 28;ciaa1268. doi: 10.1093/cid/ciaa1268.

Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between February 15 and April 20, 2020 were assessed. A total of 11,721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1,967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or preexisting cardiovascular disease were associated with an increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with an increased odds of death (all p& 0.001).

An initial report from the French SOT COVID Registry suggests high mortality due to Covid-19 in recipients of kidney transplants

Sophie Caillard et al.
Kidney Int 2020 Aug 24;S0085-2538(20)30961-3.doi: 10.1016/j.kint.2020.08.005.

This study included 279 patients in French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Multivariable analysis identified overweight, fever, and dyspnea as independent risk factors for severe disease, whereas age over 60 years, cardiovascular disease, and dyspnea were independently associated with mortality. 

Outcomes of Critically Ill Solid Organ Transplant Patients with COVID-19 in the United States

Miklos Z Molnar et al.
Am J Transplant 2020 Aug 26.doi: 10.1111/ajt.16280.

This study analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 68 hospitals across the United States from March 4th to May 8th , 2020. From 4,153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk[RR] 0.92 [95% Confidence Interval(CI):0.70-1.22]). There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR[95%CI]:1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.

August 25 - The 2020 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation was developed to assist healthcare professionals throughout the world evaluating and managing patients who are potential candidates for deceased or living donor kidney transplantation.

READ THE FULL ARTICLE

Aug. 25 - Several respiratory viruses are known to cause acute respiratory distress syndrome (ARDS). Survival and lung recovery rates are well known for influenza viruses; however, ARDS related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has posed an unprecedented challenge. Lung transplantation has been offered as a life-saving therapy for some patients with COVID-19 who have presented with persistent lung failure despite several weeks or months of support in the intensive care unit (ICU). To date, only a handful of cases have been reported via the media or scientific reports.

READ THE FULL ARTICLE

Aug. 25 - A liver grown in the lymph nodes of a pig could bring hope to patients dealing with liver disease, according to a new study. Researchers out of the University of Pittsburgh School of Medicine showed that pigs with damaged livers were able to use their own hepatocytes - a type of liver cell that functions as a natural regenerator, to grow a new organ in their lymph nodes, according to the study in journal Liver Transplantation.

READ THE FULL ARTICLE

Aug. 27 - A study of patients hospitalized with COVID-19 across the United States showed little difference in outcomes between solid organ transplant recipients and the general population.

READ THE FULL ARTICLE

Aug. 25 - Patients who underwent an organ transplant and were diagnosed with conjunctival squamous cell carcinoma presented with greater tumor thickness and larger basal diameter compared with patients who did not undergo an organ transplant.

READ THE FULL ARTICLE

Aug. 26 - Transplantation is the accepted treatment for many patients with chronic or acute advanced organ disease and certain types of cancer. Currently, there are over 120,000 patients in the US waiting for solid organ transplant (nearly 100,000 are kidney transplant candidates), and the wait list continues to grow.

READ THE FULL ARTICLE

In accordance with the TTS By-Laws, a Business Meeting will be held shortly after the close of the TTS 2020 Virtual Congress. The meeting will be help on Sunday, September 20, at 8 AM Montreal time and will last approximately one hour. The agenda will include an update on the TTS finances, the announcement of the TTS 2024 Congress location, a presentation for the TTS 2022 Congress in Buenos Aires, the announcement of the 2020-2022 Councilors and Officers and the official change of TTS Presidency. All members are invited to participate.

As this meeting will be virtually, we will send all members a link to join this meeting shortly before the meeting takes place.

Sincerely,

John Fung
Secretary, The Transplantation Society

CLICK HERE TO VISIT THE WEBSITE

CLICK HERE TO VISIT THE WEBSITE

CLICK HERE TO VISIT THE WEBSITE

TTS members are invited to attend the FOCIS 2020 Virtual Annual Meeting – THE meeting in translational immunology!

The Federation of Clinical Immunology Societies exists to improve human health through immunology.

The FOCIS 2020 Virtual Annual Meeting on October 28-31, 2020, brings together an interdisciplinary group of world-renowned physicians and researchers to share the latest findings on diseases impacting the immune system.

CLICK HERE FOR DETAILS

CLICK HERE TO VISIT THE WEBSITE