COVID-19 in solid organ transplant recipients: A single-center case series from Spain

Abstract

The clinical characteristics, management, and outcome of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after solid organ transplant (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%], and heart [22.2%]) recipients diagnosed with COVID-19 by March 23, 2020 at a tertiary-care center at Madrid. Median age at diagnosis was 71.0 ± 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine) was used in 50.0% of patients and had to be prematurely discontinued in 2 of them. Other antiviral regimens included hydroxychloroquine monotherapy (27.8%) and interferon-β (16.7%). As of April 4, the case-fatality rate was 27.8% (5/18). After a median follow-up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C-reactive protein levels at various points were significantly higher among recipients who experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS-CoV-2 infection has a severe course in SOT recipients.

Keywords: COVID-19; SARS-CoV-2; coronavirus; outcome; solid organ transplantation; treatment.

FIGURE 1

Evolution of laboratory parameters in SOT recipients with available data (n = 17): A, C-reactive protein; B, lactate dehydrogenase; and C, absolute lymphocyte count. Dots represent median values and bars indicate 95% confidence intervals in the overall cohort and patients with favorable and unfavorable outcome (middle gray, clear gray, and black, respectively). Cases 1, 3, 4, 7, 8, 10, 12, 15, and 17 were classified within the unfavorable outcome group. *P < 0.05; **P < 0.01; ***P ≤ 0.001 (for comparisons between recipients with favorable and unfavorable outcomes)

FIGURE 2

Results of therapeutic drug monitoring of tacrolimus in 5 recipients that received lopinavir/ritonavir (LPV/r). Circles and horizontal bars represent individual and median values, respectively