Session Name: COVID-19
Session Date & Time: None. Available on demand.
*Purpose: Southern CA is at the epicenter of the Covid-19 pandemic. We reviewed outcomes of our center’s liver, kidney, and pancreas transplant patients stricken with Covid-19 infection.
*Methods: Retrospective review of 161 post-transplant patients with Covid-19 infection.
*Results: From March 2020 to January 2021, 43 liver, 107 kidney, 6 liver/kidney, and 4 kidney/pancreas patients came down with Covid-19 (TABLE). Transplants were performed from August 2000 to December 2020. Mean age was 54±1 yrs. Median time of infection was 27 months post-transplant (range 15 days to 21 years). Frequency of symptoms were: shortness of breath (55%), fever (52%), muscle aches (48%), diarrhea (36%), headaches (34%), loss of taste or smell (27%). Only 10 (6%) pts were asymptomatic. Overall mortality rate was 20% (33/161) and severe Covid-19 (hospitalization and death) occurred in 90/161 (56%) patients. Mortality risk factors included older age (62±2 vs 52±1 yrs, p<0.01), hospitalization (32/33, 97% vs 59/128, 46% p<0.01), mechanical ventilation (30/33, 91% vs 4/128, 3% p<0.01); there was no difference in gender (p=0.5), race (p=0.88), presence of diabetes (p=0.26), hypertension (p=0.06), or obesity (p=0.83). Liver/kidney recipients had the highest mortality rate (Table). Risk factors for severe Covid-19 included age (56±1 vs 51±2 yrs, P=0.01) and presence of diabetes (54/90, 60% vs 29/71, 41% p=0.02); there was no difference in gender (p=0.97), race (p=0.39), presence of hypertension (p=0.09), or obesity (p=0.82). Kidney patients had more severe Covid-19 than the other organ recipients. Kidney/pancreas patients were younger and tended to have mild infection and had no mortality. 156 (97%) patients were on tacrolimus (2 were on CyA, 2 on belatacept), 113 (70%) on MMF, and 127 (79%) on prednisone. 101 (63%) of patients were on triple immunosuppression. MMF was the most common agent to be adjusted (48/113, 42%) followed by tacrolimus (9/156, 6%). Of the 90 pts hospitalized, 70 (78%) received steroids, 30 (33%) received Remdesivir, and 53 (59%) were anticoagulated. 5 patients received convalescent plasma. Peak C-reactive protein levels when measured were significantly higher in patients who died (53.7±15.8 vs 19.8±5.3 mg/L, p=0.02).
*Conclusions: Covid-19 infection inflicts a high mortality rate in liver, kidney, and pancreas transplant recipients.
|Liver (n=43)||Liver/kidney (n=6)||Kidney (n=107)||Kidney/pancreas (n=4)|
|Severe Covid-19||19/43 (45%)||3/6 (50%)||67/107 (63%)||1/4 (25%)|
|Mortality||6/43 (14%)||3/8 (37%)||24/107 (22%)||0/4|
To cite this abstract in AMA style:Vera MEde, Woloszyn J, Regmi S, Rattanavich R, Rakoski M, Lin M, Mehta P, Kore A, Weissman J, Martens C, Phan T, Jerez-Aguilar B, Robinson M, Wells E, Villicana R, Nguyen M. Covid-19 Infections Post-liver and Kidney Transplantation in a Southern Ca Program [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/covid-19-infections-post-liver-and-kidney-transplantation-in-a-southern-ca-program/. Accessed June 12, 2021.
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