Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics

Afrah S. Sait, MD; Teresa Po-Yu Chiang, MD, MPH; Kieren A. Marr, MD, MBA; Allan B. Massie, PhD; Willa Cochran, CRNP; Pali Shah, MD; Daniel C. Brennan, MD; Alvin G. Thomas, MS; Seema Mehta Steinke, MD, MS; Nitipong Permpalung, MD, MPH; Shmuel Shoham, MD; Christian Merlo, MD; Tania Jain, MD; Brian Boyarsky, MD; Olga Charnaya, MD; Ahmet Gurakar, MD; Kavita Sharma, MD; Christine M. Durand, MD; William A. Werbel, MD; Chiung-Yu Huang, PhD; Darin Ostrander, PhD; Niraj Desai, MD; Min Young Kim, MD; Sami Alasfar, MD; Evan M. Bloch, MD, PhD; Aaron A.R. Tobian, MD PhD; Jacqueline Garonzik-Wang, MD, PhD; Dorry L. Segev, MD, PhD; Robin K. Avery, MD

doi:10.1097/TXD.0000000000001268

Transplantation Direct (Jan 2022)

Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics

Afrah S. Sait, MD,
Teresa Po-Yu Chiang, MD, MPH,
Kieren A. Marr, MD, MBA,
Allan B. Massie, PhD,
Willa Cochran, CRNP,
Pali Shah, MD,
Daniel C. Brennan, MD,
Alvin G. Thomas, MS,
Seema Mehta Steinke, MD, MS,
Nitipong Permpalung, MD, MPH,
Shmuel Shoham, MD,
Christian Merlo, MD,
Tania Jain, MD,
Brian Boyarsky, MD,
Olga Charnaya, MD,
Ahmet Gurakar, MD,
Kavita Sharma, MD,
Christine M. Durand, MD,
William A. Werbel, MD,
Chiung-Yu Huang, PhD,
Darin Ostrander, PhD,
Niraj Desai, MD,
Min Young Kim, MD,
Sami Alasfar, MD,
Evan M. Bloch, MD, PhD,
Aaron A.R. Tobian, MD PhD,
Jacqueline Garonzik-Wang, MD, PhD,
Dorry L. Segev, MD, PhD,
Robin K. Avery, MD

Affiliations

Afrah S. Sait, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Teresa Po-Yu Chiang, MD, MPH: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Kieren A. Marr, MD, MBA: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Allan B. Massie, PhD: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Willa Cochran, CRNP: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Pali Shah, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Daniel C. Brennan, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Alvin G. Thomas, MS: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Seema Mehta Steinke, MD, MS: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Nitipong Permpalung, MD, MPH: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Shmuel Shoham, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Christian Merlo, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Tania Jain, MD: 6 Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD.
Brian Boyarsky, MD: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Olga Charnaya, MD: 7 Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Ahmet Gurakar, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Kavita Sharma, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Christine M. Durand, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
William A. Werbel, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Chiung-Yu Huang, PhD: 8 Department of Statistics, University of California at San Francisco, San Francisco, CA.
Darin Ostrander, PhD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Niraj Desai, MD: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Min Young Kim, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Sami Alasfar, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Evan M. Bloch, MD, PhD: 9 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Aaron A.R. Tobian, MD PhD: 9 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Jacqueline Garonzik-Wang, MD, PhD: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Dorry L. Segev, MD, PhD: 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Robin K. Avery, MD: 1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

DOI: https://doi.org/10.1097/TXD.0000000000001268
Journal volume & issue: Vol. 8, no. 1
p. e1268

Abstract

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Background. Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections. Methods. We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March–May 2020, 21 patients; and Era 2: June–November 2020, 56 patients) and 52 solid organ transplant outpatients. Results. In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post–COVID-19 renal and liver function were comparable between eras, out to 90 d. Conclusions. Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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