COVID‐19 in solid organ transplant recipients: Dynamics of disease progression and inflammatory markers in ICU and non‐ICU admitted patients

• Published in: Transplant infectious disease Vol. 22; no. 5; pp. e13407 - n/a
• Main Authors: Roberts, Matthew B., Izzy, Saef, Tahir, Zabreen, Al Jarrah, Ali, Fishman, Jay A., El Khoury, Joseph
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-10-2020; John Wiley and Sons Inc
• Subjects: Adult; Aged; Biomarkers; Biomarkers - blood; C-Reactive Protein - analysis; C-Reactive Protein - immunology; COVID-19; COVID-19 - blood; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - immunology; Critical Illness - mortality; cytokines; Demographics; Demography; Dimers; Disease Progression; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic medical records; Female; Ferritin; Graft rejection; Graft Rejection - epidemiology; Graft Rejection - immunology; Graft Rejection - prevention & control; Hospital Mortality; hospitalization; Humans; Illnesses; Immunocompromised Host; Immunosuppression; Immunosuppression - adverse effects; Immunosuppression - methods; Immunosuppressive Agents - adverse effects; Infections; inflammation; Intensive Care Units - statistics & numerical data; Laboratories; Laboratory tests; Lymphocytes; Male; Massachusetts - epidemiology; Middle Aged; Organ Transplantation - adverse effects; Original Report; Original Reports; Pandemics; Patient Admission - statistics & numerical data; Patients; Rejection; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; Severity of Illness Index; Signs and symptoms; solid organ transplantation; Transplant Recipients - statistics & numerical data; Viral diseases; Massachusetts; COVID-19; immunosuppression; solid organ transplantation; cytokines; hospitalization; inflammation
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13407

Background
COVID‐19 infection varies in severity from minimal symptoms to critical illness associated with a hyperinflammatory response. Data on disease progression in immunosuppressed solid organ transplant (SOT) recipients are limited.
Methods
We examined the electronic medical records of all SOT recipients with COVID‐19 from 12 Massachusetts hospitals between February 1, and May 6, 2020. We analyzed the demographics, clinical parameters, course, and outcomes of illness in these patients.
Results
Of 52 COVID‐19‐positive SOT patients, 77% were hospitalized and 35% required ICU admission. Sixty‐nine percent of hospitalized patients had immunosuppression reduced, 6% developed suspected rejection. Co‐infections occurred in 45% in ICU vs 5% in non‐ICU patients (P = .037). A biphasic pattern of evolution of laboratory tests was observed. In the first 5 days of illness, inflammatory markers were moderately increased. Subsequently, WBC, CRP, ferritin, and D Dimer increased with increasing stay in the ICU, and lymphocyte counts were similar. Five patients (16%) died.
Conclusions
Our data indicate that SOT is associated with high rate of hospitalization, ICU admission, and death from COVID‐19 compared to data in the general population of patients with COVID‐19. Despite reduction in immunosuppression, suspected rejection was rare. The clinical course and trend of laboratory biomarkers is biphasic with a later, pronounced peak in inflammatory markers seen in those admitted to an ICU. CRP is a useful marker to monitor disease progression in SOT.