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Coronavirus disease 2019 in solid organ transplant recipients in a setting of proactive screening and contact tracing


 Background: As of 26 June 2020, the global number of infections caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), had reached 11 million, with more than 500 thousand associated deaths. Limited clinical information about COVID-19 on solid organ transplant (SOT) are available so far. We herein report our preliminary experience with COVID-19 in SOT recipients in the first few weeks of the outbreak in Qatar. Method: All SOT recipients with laboratory-confirmed COVID-19 up to 23 May 2020 were included. Baseline characteristics, antivirals and immunosuppressive management, complications, and outcomes were retrospectively extracted from the electronic health system. Categorical data are summarized as frequency and percentages, while continuous variables are presented as medians and ranges. Results: Twenty-four SOT patients with COVID-19 were included in this report (kidney: 16, liver: 6, heart: 1, and combined liver and kidney: 1). The median age was 57 years (range 24–72). Thanks to proactive screening, five (21%) asymptomatic cases were diagnosed . Among the other 19 symptomatic patients, fever (15/19) and cough (13/19) were the most frequent presenting symptoms. All patients were hospitalized; 5 (21%) required invasive mechanical ventilation in the intensive care unit (ICU). Eleven (46%) patients developed acute kidney injury as a complication, including 3 in association with drug-drug interactions involving investigational COVID-19 therapies . Maintenance of immunosuppressive therapy was changed in 18 (75%) patients, but systemic corticosteroids were not withdrawn in any. After a median follow up of 43 days (26–89), 18 (75%) patients had been discharged home, 3 (12.3%) were still hospitalized, 2 (8.3%) were still in ICU, and 1 (4.2%) had died .
 
 Conclusion: Although higher mortality rates were observed in other reports, our results suggest that asymptomatic COVID-19 is possible in SOT recipients and that overall outcomes are not consistently worse than other immunocompetent patients. The results require validation in larger cohorts.