Transplantation Direct (Dec 2020)

Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know

  • Arpita Basu, MD, MPH,,
  • Rachel Patzer, PhD, MPH,,
  • Darya Hosein, BS,,
  • Zhensheng Wang, PhD, MPH,,
  • Nitika Sharma, MS,,
  • Harold Franch, MD,,
  • Frederic Rahbari Oskoui, MD,,
  • Divya Gupta, MD,,
  • Ram Subramanian, MD,,
  • Lakshmi Sridharan, MD,,
  • Wanda Allison, RN, BSN, CCTC,
  • Stephen Pastan, MD,,
  • Christian Larsen, MD

DOI
https://doi.org/10.1097/TXD.0000000000001074
Journal volume & issue
Vol. 6, no. 12
p. e633

Abstract

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Background. The current surge of coronavirus 2019 (COVID-19) cases in certain parts of the country has burdened the healthcare system, limiting access to tertiary centers for many. As a result, COVID-19-positive Solid Organ Transplant (SOT) recipients are increasingly being managed by local healthcare providers. It is crucial for community providers to understand disease severity and know if COVID-19-impacted SOT recipients have a different clinical course compared with COVID-19-negative SOT recipients with a similar presentation. Methods. We conducted a retrospective analysis on SOT recipients suspected to have COVID-19 infection tested during March 14, 2020–April 30, 2020. Patients were followed from time of testing to May 31, 2020. Results. One hundred sixty SOT recipients underwent testing: 22 COVID-19 positive and 138 COVID-19 negative. COVID-19-positive patients were more likely to have rapid progression of symptoms (median 3 vs 6 d, P = 0.002), greater hospitalizations (78% vs 64%, P < 0.017), and need for intensive care unit care (45% vs 17%, P < 0.001) Severe COVID-19 infection was not observed in patients on Belatacept for immunosuppression (30% vs 87%,P = 0.001). COVID- 19 positive patients in the intensive care unit were more likely to have multifocal opacities on radiological imaging in comparison to those admitted to the medical floor (90% vs 11%). Survival probability was similar in both cohorts. Conclusion. COVID-19-infected SOT recipients have a propensity for rapid clinical decompensation. Local providers need to be work closely with transplant centers to appropriately triage and manage COVID-19 SOT recipients in the community.