COVID-19-Associated Graft Loss From Renal Infarction in a Kidney Transplant Recipient.
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ABSTRACT:
SUBMITTER: Webb C
PROVIDER: S-EPMC7849536 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
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COVID-19-Associated Graft Loss From Renal Infarction in a Kidney Transplant Recipient.
Webb Christine C Davidson Bianca B Jones Erika S W ESW Wearne Nicola N Chetty Dharshnee Rama DR Blom Dirk D Barday Zunaid Z
Kidney international reports 20210201 4
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Project description:We report a case of a 50-year-old male with a history of HIV and kidney transplant who presented with SARS-CoV-2. We also present a review of COVID-19 cases in kidney transplant recipients.
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Project description:We report a case of a kidney transplant recipient who presented with acute kidney injury and nephrotic-range proteinuria in a context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Kidney biopsy revealed collapsing glomerulopathy. Droplet-based digital polymerase chain reaction did not detect the presence of SARS-CoV-2 RNA in the biopsy fragment, and the virus was barely detectable in plasma at the time of the biopsy. SARS-CoV-2 RNAemia peaked several days later, followed by a seroconversion despite the absence of circulating CD19-positive lymphocytes at admission due to rituximab-based treatment of antibody-mediated rejection 3 months earlier. Genotyping for the 2 risk alleles of the apolipoprotein L1 (APOL1) gene revealed that the donor carried the low-risk G0/G2 genotype. This case illustrates that coronavirus disease 2019 infection may promote a collapsing glomerulopathy in kidney allografts with a low-risk APOL1 genotype in the absence of detectable SARS-CoV-2 RNA in the kidney and that podocyte injury may precede SARS-CoV-2 RNAemia.
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Project description:To examine whether a higher body mass index (BMI) in kidney recipients is associated with delayed graft function (DGF), we analyzed data from 11,836 hemodialysis patients in the Scientific Registry of Transplant Recipients who underwent kidney transplantation. The patient cohort included women, blacks, and diabetics; the average age was 49 years; and the mean BMI was 26.8 kg/m(2). After adjusting for relevant covariates, multivariate logistic regression analyses found that one standard deviation increase in pretransplant BMI was associated with a higher risk of DGF (odds ratio (OR) 1.35). Compared with patients with a pretransplant BMI of 22-24.99 kg/m(2), overweight patients (BMI 25-29.99 kg/m(2)), mild obesity patients (BMI 30-34.99 kg/m(2)), and moderate-to-severe obesity patients (BMI 35 kg/m(2) and over) had a significantly higher risk of DGF, with ORs of 1.30, 1.42, and 2.18, respectively. Similar associations were found in all subgroups of patients. Hence, pretransplant overweight or obesity is associated with an incrementally higher risk of DGF.
| S-EPMC5489124 | biostudies-literature
Project description:The COVID-19 pandemic has challenged the delivery of health services. Telehealth allows delivery of care without in-person contacts and minimizes the risk of vial transmission. We aimed to describe the perspectives of kidney transplant recipients on the benefits, challenges, and risks of telehealth. We conducted five online focus groups with 34 kidney transplant recipients who had experienced a telehealth appointment. Transcripts were thematically analyzed. We identified five themes: minimizing burden (convenient and easy, efficiency of appointments, reducing exposure to risk, limiting work disruptions, and alleviating financial burden); attuning to individual context (depending on stability of health, respect patient choice of care, and ensuring a conducive environment); protecting personal connection and trust (requires established rapport with clinicians, hampering honest conversations, diminished attentiveness without incidental interactions, reassurance of follow-up, and missed opportunity to share lived experience); empowerment and readiness (increased responsibility for self-management, confidence in physical assessment, mental preparedness, and forced independence); navigating technical challenges (interrupted communication, new and daunting technologies, and cognizant of patient digital literacy). Telehealth is convenient and minimizes time, financial, and overall treatment burden. Telehealth should ideally be available after the pandemic, be provided by a trusted nephrologist and supported with resources to help patients prepare for appointments.
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Project description:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly infecting people worldwide, resulting in the infectious disease coronavirus disease 19 (COVID-19) that has been declared a pandemic. Much remains unknown about COVID-19, including its effects on solid organ transplant (SOT) recipients. Given their immunosuppressed state, SOT recipients are presumed to be at high risk of complications with viral infections such as SARS-CoV-2. Limited case reports in single SOT recipients, however, have not suggested a particularly severe course in this population. In this report, we present a dual-organ (heart/kidney) transplant recipient who was found to have COVID-19 and, despite the presence of a number of risk factors for poor outcomes, had a relatively mild clinical course.
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Project description:IntroductionCertain ABO blood types have been linked to cardiovascular disease, infection and cancers. The effect of recipient ABO blood group on patient and graft survival has not been studied in ABO-matched kidney transplantation. This study aims to determine the association between kidney transplant recipient ABO blood groups with patient and graft survival in Australian and New Zealand.MethodsAll Australian and New Zealand transplant recipients who received ABO-compatible primary kidney transplants between 1995-2016 were analysed using a de-identified dataset from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Primary analysis was undertaken of recipient ABO blood group O versus non-O blood groups. The primary outcome was patient survival post kidney transplantation and the secondary outcome was death censored graft survival. Recipient age at first transplant, gender, ethnicity, body mass index, smoking status, vascular disease, presence of diabetes mellitus, chronic lung disease, primary kidney disease, donor source, donor age and gender, and era of transplants were included in the multivariate model as confounders.Results and conclusionsOn analysis of 15,523 kidney transplant recipients, blood group O was not associated with patient survival (hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.89-1.04) nor death censored graft survival (HR 0.97, 95% CI 0.89-1.05) compared to non-blood group O recipients. Competing risks analyses showed an increased risk of cancer-related mortality in blood group O recipients on univariate analyses (HR 1.18, 95% CI 1.01-1.37) however, this became insignificant on multivariate analyses. On secondary analyses, recipient blood group AB (4.11% participants) was associated with inferior death censored graft survival compared to those with blood group O (HR 1.24, 95% CI 1.02-1.50). Although recipient ABO blood groups were not associated with patient nor graft survival, differences in cause-specific mortality between individual blood groups cannot be excluded based on current analyses.
| S-EPMC7377395 | biostudies-literature
Project description:Since December 2019, a novel coronavirus that caused viral pneumonia broke out and became global pandemic. Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus. Reports on the clinical manifestations in solid organ transplant (SOT) recipients are rare. We report the clinical features and treatment of a Chinese renal transplant recipient with COVID-19. A 46-year-old Chinese woman, who had a renal transplant in 2006 due to chronic glomerulonephritis, was admitted to Renmin Hospital of Wuhan University for fever, cough, and expectoration for more than 10 days and diarrhea for 3 days. At admission, her body temperature was 38.2 °C and pulse oxygen saturation was 96% under oxygen inhalation. There were decreased breath sounds bilaterally. Laboratory data revealed normal leucocyte count, a normal percentage of neutrophils, a normal percentage of lymphocytes, decreased lymphocyte count, elevated procalcitonin and C-reactive protein (CRP), and increased levels of urea, creatinine, and estimated glomerular filtration rate. COVID-19 was confirmed by nasopharyngeal swab and sputum which were positive for SARS-CoV-2 by real-time reverse transcription PCR (RT-PCR). Chest CT revealed multiple patchy and flake ground-glass shadows in bilateral lung fields, and strip shadows in bilateral lower lobes. Treatment included antiviral (umifenovir, hydroxychloroquine), antibacterial (moxifloxacin), and other support therapies. Her symptoms, laboratory data, and chest CT showed trends of gradual improvement, while nasopharyngeal swabs were always positive for SARS-CoV-2. She was finally discharged from hospital on her 70th day of hospitalization when 2 consecutive nasopharyngeal swabs were negative for SARS-CoV-2. This is a rare report on COVID-19 in a renal transplant recipient, which can help enhance the understanding and treatment of COVID-19 in renal transplant recipients.
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Project description:Coronavirus disease 2019 (COVID-19) pneumonia has been poorly reported in solid organ transplanted patients; prognosis is uncertain and best management unclear. We describe the case of a 61-year-old kidney transplant recipient with several comorbidities who was hospitalized and later received a diagnosis of COVID-19 pneumonia; the infection was successfully managed with the use of hydroxychloroquine and a single administration of tocilizumab, after immunosuppression reduction; the patient did not require mechanical ventilation. During the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, transplant clinicians should be readily informed about new cases of COVID-19 pneumonia in solid organ transplant recipients, with focus on therapeutic strategies employed and their outcome.
| S-EPMC7264495 | biostudies-literature
Project description:Patients facing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infections with comorbidities, especially patients whose immune system is weakened have higher chances to face severe outcomes. One of the main reasons behind the suppression of the immune system is iatrogenic, in patients who have autoimmune diseases and/or had an organ transplant. Although there are studies that are examining immunocompromised and/or transplanted patients with COVID-19 infection, furthermore there is a limited number of studies available which are dealing with COVID-19 in pregnant women; however, it is unique and is worth reporting when these factors are coexisting. In this study, we present the case of a 33-year-old Caucasian pregnant woman, who had a kidney transplant in 2009 and contracted the SARS-CoV-2 virus on the 26th gestational week, in 2021. After her infection, superimposed preeclampsia was diagnosed and due to the worsening flowmetric parameters, she gave birth to a premature male newborn with cesarean section. Our kidney transplant patient's case highlights how COVID-19 disease can lead to preeclampsia and artificial termination of gestation.
| S-EPMC9468219 | biostudies-literature
Project description:ObjectivesTo investigate racial and ethnic differences in graft and recipient survival in elderly kidney transplant recipients.DesignRetrospective cohort.SettingFirst-time, kidney-only transplant recipients aged 60 and older of age at transplantation transplanted between July 1996 and October 2010 (N = 44,013).ParticipantsUnited Network for Organ Sharing (UNOS) database.MeasurementsTime to graft failure and death obtained from the UNOS database and linkage to the Social Security Death Index. Neighborhood poverty from 2000 U.S. Census geographic data.ResultsOf the 44,013 recipients in the sample, 20% were black, 63% non-Hispanic white, 11% Hispanic, 5% Asian, and the rest "other racial groups." In adjusted Cox models, blacks were more likely than whites to experience graft failure (hazard ratio (HR) = 1.23, 95% confidence interval (CI) = 1.15-1.32), whereas Hispanics (HR = 0.77, 95% CI = 0.70-0.85) and Asians (HR = 0.70, 95% CI = 0.61-0.81) were less likely to experience graft failure. Blacks (HR = 0.84, 95% CI = 0.80-0.88), Hispanics (HR = 0.68, 95% CI = 0.64-0.72), and Asians (HR = 0.62, 95% CI = 0.57-0.68) were less likely than whites to die after renal transplantation.ConclusionElderly blacks are at greater risk of graft failure than white transplant recipients but survive longer after transplantation. Asians have the highest recipient and graft survival, followed by Hispanics. Further studies are needed to assess additional factors affecting graft and recipient survival in elderly adults and to investigate outcomes such as quality of life.
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