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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 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%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day mortality 22.8%). 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. Thus, Covid-19 in recipients of kidney transplants portends a high mortality rate. Proper management of immunosuppression and tailored treatment of this population remain challenging.

Graphical abstract

Related collections

Most cited references 18

Record: found
Abstract: found
Article: not found

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

0 comments Cited 13447 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

COVID-19: consider cytokine storm syndromes and immunosuppression

Puja Mehta, Daniel McAuley, Michael Brown … (2020)

As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, 1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. 2 Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections 3 and occurs in 3·7–4·3% of sepsis cases. 4 Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients. 5 A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. 6 Predictors of fatality from a recent retrospective, multicentre study of 150 confirmed COVID-19 cases in Wuhan, China, included elevated ferritin (mean 1297·6 ng/ml in non-survivors vs 614·0 ng/ml in survivors; p 39·4°C 49 Organomegaly None 0 Hepatomegaly or splenomegaly 23 Hepatomegaly and splenomegaly 38 Number of cytopenias * One lineage 0 Two lineages 24 Three lineages 34 Triglycerides (mmol/L) 4·0 mmol/L 64 Fibrinogen (g/L) >2·5 g/L 0 ≤2·5 g/L 30 Ferritin ng/ml 6000 ng/ml 50 Serum aspartate aminotransferase <30 IU/L 0 ≥30 IU/L 19 Haemophagocytosis on bone marrow aspirate No 0 Yes 35 Known immunosuppression † No 0 Yes 18 The Hscore 11 generates a probability for the presence of secondary HLH. HScores greater than 169 are 93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH. HScores can be calculated using an online HScore calculator. 11 HLH=haemophagocytic lymphohistiocytosis. * Defined as either haemoglobin concentration of 9·2 g/dL or less (≤5·71 mmol/L), a white blood cell count of 5000 white blood cells per mm3 or less, or platelet count of 110 000 platelets per mm3 or less, or all of these criteria combined. † HIV positive or receiving longterm immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).

0 comments Cited 4799 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella … (2020)

In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

0 comments Cited 2760 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Sophie Caillard

Journal

Journal ID (nlm-ta): Kidney Int

Journal ID (iso-abbrev): Kidney Int

Title: Kidney International

Publisher: Published by Elsevier, Inc., on behalf of the International Society of Nephrology.

ISSN (Print): 0085-2538

ISSN (Electronic): 1523-1755

Publication date PMC-release: 24 August 2020

Publication date (Electronic): 24 August 2020

Affiliations

[1 ]Department of Nephrology and Transplantation, Strasbourg University Hospital, INSERM, IRM UMR-S 1109, Strasbourg, France

[2 ]Service de Néphrologie et Transplantation Adultes, Hôpital Universitaire Necker – APHP Centre - Université de Paris INEM INSERM U 1151- CNRS UMR 8253, Paris, France

[3 ]AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier. Université Paris-Est-Créteil, (UPEC), DHU (Département Hospitalo-Universitaire) VIC (Virus-Immunité-Cancer), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France

[4 ]Department of Nephrology and Transplantation, Hôpital Bichat, Paris, France

[5 ]University of Lorraine, CHRU-Nancy, Department of Nephrology, Vandoeuvre, France INSERM CIC-EC CIE6, Nancy, France

[6 ]Department of Transplantation, Nephrology and Clinical Immunology, Hôpital Edouard Herriot, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France

[7 ]Aix Marseille Université, Hôpitaux Universitaires de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France

[8 ]Department of Nephrology and Transplantation, University of Amiens, Amiens, France

[9 ]Department of Nephrology and Transplantation, University of Toulouse, Toulouse, France

[10 ]Department of Nephrology and Transplantation, University of Tours, Tours, France

[11 ]Department of Nephrology and Transplantation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France

[12 ]Service de néphrologie-dialyse-transplantation, Hopital Pasteur 2, C.H.U. de Nice, Unité de Recherche Clinique Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France

[13 ]Department of Nephrology and Transplantation, University of Rouen, Rouen, France

[14 ]Department of Nephrology and Transplantation, University of Reims, Reims, France

[15 ]Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, CHU de Bordeaux Pellegrin. Unité Mixte de Recherche “ImmunoConcEpT” 5164 - Université de Bordeaux, France

[16 ]Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, CIC-P 1414, Rennes, France

[17 ]Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Nantes, Nantes, France

[18 ]Department of Nephrology, University of Besançon, Besançon, France

[19 ]Department of Nephrology and Transplantation, University of Angers, Angers, France

[20 ]Department of Nephrology and Transplantation, University of Caen, Caen, France

[21 ]Department of Nephrology, CHU de Brest, UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, Brest, France

[22 ]Department of Nephrology and Transplantation, University of Lille, Lille, France

Author notes

[∗∗ ]Corresponding author: Sophie Caillard, Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France, 1 place de l’hopital, 67091 Strasbourg Cedex, FranceTel: 0033369551320 Sophie.caillard@ 123456chru-strasbourg.fr

[∗]

French SOT COVID Registry

Article

Publisher ID: S0085-2538(20)30961-3

DOI: 10.1016/j.kint.2020.08.005

PMC ID: 7444636

PubMed ID: 32853631

SO-VID: 14c18603-0ef4-441c-877b-defbf0f4137c

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 22 May 2020

Date revision received : 4 August 2020

Date accepted : 13 August 2020

Comments

Comment on this article

scite_

Cited by 126

See all cited by

Most referenced authors 1,275

See all reference authors

- Version 1

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

Read this article at

Abstract

Graphical abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 18

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

COVID-19: consider cytokine storm syndromes and immunosuppression

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 123

Cited by 126

Most referenced authors 1,275