Abstract
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.
Keywords: COVID-19; cytokines; hospitalization; immunosuppression; inflammation; solid organ transplantation.
【저자키워드】 COVID-19, Inflammation, Cytokines, Hospitalization, solid organ transplantation, Immunosuppression, 【초록키워드】 Evolution, Critical illness, Cytokines, Hospitalized, severity, hospital, inflammatory markers, solid organ transplantation, Immunosuppression, CRP, ferritin, Laboratory tests, Symptom, outcome, hospitalized patients, ICU, D dimer, Disease progression, Lymphocyte count, lymphocyte, Clinical course, COVID-19 infection, Patient, ICU admission, death, Inflammatory marker, laboratory biomarkers, WBC, General population, electronic medical records, Critical, parameters, patients, solid organ transplant, Clinical parameters, marker, Hyperinflammatory response, organ transplantation, Immunosuppressed, solid organ, SOT, demographics, Laboratory test, medical records, non-ICU, dimer, lymphocyte counts, non-ICU patients, recipient, rejection, MONITOR, Hyperinflammatory, electronic medical record, Course, analyzed, occurred, examined, died, required, reduced, hospitalized patient, Massachusett, reduction in, laboratory biomarker, non-ICU patient, patients with COVID-19, SOT patients, with COVID-19, 【제목키워드】 Dynamics, ICU, Inflammatory marker, solid organ transplant, solid organ, Admitted Patient,