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Antal O, Daciana Elec A, Muntean A, Moisoiu T, Melinte RM, Elec FI. The immunologically high-risk kidney recipient in the early post-COVID-19 period. To do or not to do? A case report. Front Med (Lausanne) 2023; 10:1147835. [PMID: 37035338 PMCID: PMC10076652 DOI: 10.3389/fmed.2023.1147835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Kidney transplantation is nowadays the treatment of choice for end-stage kidney disease (ESKD), and it is the most performed organ transplantation. During the COVID-19 pandemic, kidney-transplant recipients appeared to be at higher risk of morbidity and mortality due to severe forms of illness. The result was a decrease in the number of solid organs transplants worldwide, with patients' reduced chance of receiving transplants. The best timing for surgery after COVID-19 infection is still controversial since most of the available data come from study periods with zero or low prevalence of vaccination and COVID-19 variants with high mortality rates. The American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation (APSF) Joint Statement on Elective Surgery/Procedures and Anesthesia for Patients after COVID-19 Infection states that elective surgery should be delayed for 7 weeks after a SARS-CoV-2 infection in unvaccinated patients while making no clear statement for vaccinated ones, or those which have already been infected with the virus. Kidney transplant, as opposed to tissue transplant, is not an elective surgery, so the question raised is whether to do it or not. We present the case of a hyper-immunized 47-year-old male patient with end-stage chronic kidney disease who received a second kidney transplant, despite having a mild SARS-COV 2 infection just 2 weeks before his transplantation surgery.
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Affiliation(s)
- Oana Antal
- Department of Anaesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Alina Daciana Elec
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Adriana Muntean
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Razvan Marian Melinte
- Department of Anatomy, Dimitrie Cantemir University, Târgu-Mureş, Romania
- Department of Orthopedics and Trauma Surgery, Humanitas Hospital, Cluj-Napoca, Romania
- *Correspondence: Razvan Marian Melinte
| | - Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Anatomy, Dimitrie Cantemir University, Târgu-Mureş, Romania
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Juric I, Katalinic L, Furic-Cunko V, Basic-Jukic N. Kidney Transplantation in Patients With the History of SARS-CoV-2 Infection. Transplant Proc 2022; 54:2673-2676. [PMID: 36184341 PMCID: PMC9444488 DOI: 10.1016/j.transproceed.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study is to present the experience and results of kidney transplantation in patients with the history of SARS-CoV-2 infection. METHODS We retrospectively analyzed waitlisted patients who had a history of SARS-CoV-2 infection and offered a kidney transplant between March 2020 and December 2021. RESULTS Of the 97 waitlisted potential kidney transplant recipients who were offered a kidney, 13 (13.4%) had a history of SARS-CoV-2 infection. All patients were tested negative for SARS-CoV-2 at the time of the kidney offer. Successful transplantation was performed in 9 patients (5 male; average age was 40.8 years), with the average time between SARS-CoV-2 infection and transplantation of 8 months. Four of 13 patients with a history of SARS-CoV-2 infection were finally not transplanted, with 2 patients not eligible for transplantation due to significant post-COVID findings in routine pretransplant chest CT scans, and 2 patients were not transplanted because of poor donor organ quality. CONCLUSIONS Kidney transplantation after SARS-CoV-2 infection is possible in a setting of full recovery from acute infection, negative PCR test, and no pneumonic infiltrates on chest CT scan. A growing number of waitlisted patients with a history of SARS-CoV-2 infection imposes the need for decision-making tools and guidelines for risk/benefit assessment in these patients.
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Affiliation(s)
- Ivana Juric
- Address correspondence to Ivana Juric, Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia. Fax: (+385) 1 2376032
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Kute VB, Guleria S, Bhalla AK, Sharma A, Agarwal SK, Sahay M, Varughese S, Prasad N, Varma PP, Shroff S, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P, Prakash J. ISOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19. Indian J Nephrol 2022; 32:288-290. [PMID: 35967531 PMCID: PMC9365002 DOI: 10.4103/ijn.ijn_120_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Sharma
- Department of Transplantation Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - P P Varma
- Department of Nephrology, Primus Super Speciality Hospital, Delhi, New Delhi, India
| | | | - Harsh Vardhan
- Department of Nephrology, Patna Medical College, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shruti Dave
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Dhamendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - Manish Rathi
- Department of Nephrology, PostgraduateInstitute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pankaj Shah
- Department of Nephrology Gujarat University of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Jai Prakash
- President, Indian Society of Organ Transplantation, Former Professor and Head Nephology Banaras Hindu University, Varanasi, Utter Pradesh, India
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4
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Kute VB, Ray DS, Aziz F, Godara SM, Hegde U, KumarBT A, Bhalla AK, Yadav DK, Singh S, Pathak V, Dalal S, Bahadur MM, Anandh U, Abraham M A, Siddini V, Das SS, Thukral S, Krishnakumar A, Sharma A, Kher V, Bansal SB, Shingare A, Narayanan R, Patel H, Gulati S, Kakde S, Bansal D, Guleria S, Khullar D, Gumber MR, Varyani U, Guditi S, Khetan P, Dave R, Mishra VV, Tullius SG, Chauhan S, Meshram HS. Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study. EClinicalMedicine 2022; 46:101359. [PMID: 35350707 PMCID: PMC8948372 DOI: 10.1016/j.eclinm.2022.101359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding Sanofi.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Deepak S. Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Feroz Aziz
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Suraj M. Godara
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Anil KumarBT
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Pathak
- Department of nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Madan M. Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Abi Abraham M
- Department of Nephrology, VPS Lakeshore Hospital, Kochi, India
| | | | - Sushree Sashmita Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arvind Krishnakumar
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Shyam B. Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ranjit Narayanan
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis Group of Hospitals, New Delhi, India
| | | | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Dinesh Khullar
- Department of Nephrology, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Manoj R. Gumber
- Department of Nephrology, Indraprastha Apollo Hospital, Ahmedabad, Gujarat, India
| | - Umesh Varyani
- Department of Nephrology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Swarnalatha Guditi
- Department of Nephrology, Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, India
| | - Prakash Khetan
- Department of Nephrology, Kingsway Hospitals, Nagpur, India
| | - Rutul Dave
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Vineet V. Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Stefan G. Tullius
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
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Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature. CURRENT TRANSPLANTATION REPORTS 2022; 9:95-107. [PMID: 35284204 PMCID: PMC8904162 DOI: 10.1007/s40472-022-00362-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Purpose of Review As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. Recent Findings We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. Summary In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.
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Villanego F, Vigara LA, Torrado J, Naranjo J, García AM, García T, Mazuecos A. SARS-CoV-2 infection on the kidney transplant waiting list: Can a patient be transplanted after COVID-19? Nefrologia 2022; 42:215-217. [PMID: 36153921 PMCID: PMC9013625 DOI: 10.1016/j.nefroe.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 04/12/2023] Open
Affiliation(s)
| | | | - Julia Torrado
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, Spain
| | - Javier Naranjo
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, Spain
| | - Ana María García
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, Spain
| | - Teresa García
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, Spain
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Matejak-Górska M, Górska H, Zielonka M, Durlik M. The course of Covid-19 infection in patients after pancreas and kidney transplantation – a single - centre observation. Transplant Proc 2022; 54:917-924. [PMID: 35459465 PMCID: PMC8923976 DOI: 10.1016/j.transproceed.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Solid graft recipients are at an increased risk of serious complications and death. Out of 130 outpatient recipients of pancreas grafts at our Clinic, 20 patients (15.73%) had a confirmed severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2). Each patient had a different course of the disease, and the forms of infection varied from mild to severe and lethal. According to recommendations, after confirmation of the infection, mycophenolate mofetil was withdrawn and the immunosuppression was based on steroids and a calcineurin inhibitor. In this study, we performed an analysis of the course of COVID-19 infection in patients after pancreatic transplantation. Twenty pancreas recipients were confirmed to have COVID-19 infections; 4 of whom required hospitalization owing to severe complications. Patients reported weakness, excessive intensity of fatigue, shortness of breath with exertion, cough, and periodically increased temperature. Weakness and fatigue persisted in these patients for about 6 weeks. In 2 patients there was a need for oxygen supplementation and empirical antibiotic. Mortality was 5%, and there was 1 graftectomy. Deterioration of either kidney or pancreas graft were not observed in any other patients. The course of SARS-CoV-2 infection in solid graft recipients is similar to that of the rest of the population. Because of immunosuppression, recipients were accustomed to avoiding crowds and complying with obligations to wear masks.
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Affiliation(s)
- Marta Matejak-Górska
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland; Center of Postgraduate Medical Education, Department of General Surgery and Transplantology, Warsaw, Poland.
| | - Hanna Górska
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Michał Zielonka
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Marek Durlik
- Department of General Surgery and Transplantology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland; Center of Postgraduate Medical Education, Department of General Surgery and Transplantology, Warsaw, Poland
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Tuschen K, Anders J, Elfanish A, Schildgen V, Schildgen O, Becker JU, Weidemann A. Renal transplantation after recovery from COVID-19 - a case report with implications for transplant programs in the face of the ongoing corona-pandemic. BMC Nephrol 2021; 22:251. [PMID: 34229622 PMCID: PMC8258483 DOI: 10.1186/s12882-021-02448-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The ongoing coronavirus pandemic has major impacts on both patients and healthcare systems worldwide, thus creating new realities. Patients on maintenance dialysis listed for renal transplantation are a vulnerable subgroup with many comorbidities and recurring contacts with the healthcare system. Due to the COVID-19 pandemic transplant numbers have dropped considerably, further increasing waiting times in this high-risk population. On the other hand, knowledge of the severity of SARS-CoV-2 infection in immunocompromised patients, development and persistence of neutralising antibodies in such patients is just emerging. It is unclear how best to address the dilemma of postponing the life-saving transplantation. CASE PRESENTATION We present a case report of a successful kidney transplantation only 65 days after the recipient was hospitalized for treatment of COVID-19 pneumonia. In a follow up of 9 months, we observed no signs of recurrent disease and transplant function is excellent. Monitoring SARS-CoV-2 antibody response demonstrates stable IgG levels. CONCLUSION This reassuring case provides guidance to transplant centers how to proceed with kidney transplantation safely during the pandemic. Careful consideration of risks and benefits of the organ offer, full recovery from COVID-19 symptoms and the presence of a positive SARS-CoV-2 IgG antibody test, qualifies for kidney transplantation.
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Affiliation(s)
- Katharina Tuschen
- Medizinische Klinik III, Nephrologie und Dialyse, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098, Paderborn, Germany.,Medizinische Klinik I, Nephrologie, Transplantation und Internistische Intensivmedizin, Krankenhaus Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Johanna Anders
- Medizinische Klinik I, Nephrologie, Transplantation und Internistische Intensivmedizin, Krankenhaus Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Amin Elfanish
- Medizinische Klinik I, Nephrologie, Transplantation und Internistische Intensivmedizin, Krankenhaus Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Verena Schildgen
- Institut für Pathologie der Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Oliver Schildgen
- Institut für Pathologie der Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | | | - Alexander Weidemann
- Medizinische Klinik III, Nephrologie und Dialyse, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098, Paderborn, Germany. .,Medizinische Klinik I, Nephrologie, Transplantation und Internistische Intensivmedizin, Krankenhaus Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany.
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9
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Kute VB, Ray DS, Yadav DK, Pathak V, Bhalla AK, Godara S, Kumar A, Guleria S, Khullar D, Thukral S, Mondal RRS, Jain M, Jha PK, Hegde U, Abraham M A, Dalal S, Patel H, Bahadur MM, Shingare A, Sharma A, Kumar Sharma R, Anandh U, Gulati S, Gumber M, Siddini V, Deshpande R, Kaswan K, Varyani U, Kakde S, Kenwar DB, Shankar Meshram H, Kher V. A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19. Transplantation 2021; 105:1423-1432. [PMID: 33724246 DOI: 10.1097/tp.0000000000003740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil Kumar
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Dinesh Khullar
- Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Raj Kumar Sharma
- Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | | | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kamal Kaswan
- Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India
| | - Umesh Varyani
- Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Deepesh B Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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10
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Natori Y, Anjan S, Martin EF, Selvagi G, Villavicencio A, Coro A, Mendez-Castaner LA, Mattiazzi A, Pagan J, Ortigosa-Goggins M, Roth D, Kupin W, O'Brien CB, Arosemena LR, Ciancio G, Burke GW, Morsi M, Figueiro JM, Chen L, Tekin A, Miyashiro R, Simkins J, Abbo LM, Vianna RM, Guerra G. When is it Safe to perform Abdominal Transplantation in patients with prior SARS-CoV-2 infection: A Case Series. Clin Transplant 2021; 35:e14370. [PMID: 34032328 PMCID: PMC8209911 DOI: 10.1111/ctr.14370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Background The Coronavirus disease 2019(COVID‐19) pandemic has negatively impacted worldwide organ transplantation. However, there is limited information on recipients transplanted after SARS‐CoV‐2 infection. A full understanding of this scenario is required, as transplantation is a life‐saving procedure and COVID‐19 remains an ongoing threat. Methods Abdominal organ transplant recipients diagnosed with COVID‐19 prior to transplantation were identified by chart review and clinical data were collected. The primary outcome was the transplant outcome including graft loss, rejection and death, and reactivation of infection post‐transplant. Results We identified 14 patients who received abdominal organ transplants after symptomatic PCR confirmed SARS‐CoV‐2 infection; four patients had a positive PCR at the time of admission for transplantation. The median time of follow‐up was 79 (22‐190) days. One recipient with negative PCR before transplant tested positive 9 days after transplant. One of 14 transplanted patients developed disseminated mold infection and died 86 days after transplant. During the follow‐up, only one patient developed rejection; thirteen patients had favorable graft outcomes. Conclusions We were able to perform abdominal transplantation for patients with COVID‐19 before transplant, even with positive PCR at the time of transplant. Larger studies are needed to determine the time to safe transplant after SARS‐CoV‐2 infection.
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Affiliation(s)
- Yoichiro Natori
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shweta Anjan
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric F Martin
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gennaro Selvagi
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aasith Villavicencio
- Department of Medicine, Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ana Coro
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lumen A Mendez-Castaner
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Adela Mattiazzi
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Javier Pagan
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Mariella Ortigosa-Goggins
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - David Roth
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Warren Kupin
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
| | - Christopher B O'Brien
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leopoldo R Arosemena
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gaetano Ciancio
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George W Burke
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mahmoud Morsi
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose M Figueiro
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Linda Chen
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Akin Tekin
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rafael Miyashiro
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacques Simkins
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilian M Abbo
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rodrigo M Vianna
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Health System, Miami, FL, USA.,Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine Miami, FL, USA
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11
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Pascual J. Kidney transplant after a COVID-19. Nefrologia 2021; 41:91-94. [PMID: 36166213 PMCID: PMC8162902 DOI: 10.1016/j.nefroe.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 04/23/2023] Open
Affiliation(s)
- Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
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12
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Villanego F, Vigara LA, Torrado J, Naranjo J, García AM, García T, Mazuecos A. SARS-CoV-2 infection on the kidney transplant waiting list: Can a patient be transplanted after COVID-19? Nefrologia 2021; 42:S0211-6995(21)00001-1. [PMID: 33500158 PMCID: PMC7796796 DOI: 10.1016/j.nefro.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Luis Alberto Vigara
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, España
| | - Julia Torrado
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, España
| | - Javier Naranjo
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, España
| | - Ana María García
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, España
| | - Teresa García
- Servicio de Nefrología, Hospital Univeristario Puerta del Mar, Cádiz, España
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13
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Pascual J. [Kidney transplant after a COVID-19]. Nefrologia 2021; 41:91-94. [PMID: 33602564 PMCID: PMC7833929 DOI: 10.1016/j.nefro.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, España
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