Abstract
Data describing the clinical progression of coronavirus disease 2019 (COVID-19) in transplant recipients are limited. In New York City during the surge in COVID-19 cases, a systematic approach to monitoring and triaging immunocompromised transplant patients was required in the context of strained healthcare resources, limited outpatient testing, and heightened hospital exposure risks. Public health guidance at the onset of the COVID-19 outbreak recommended outpatient monitoring of mildly symptomatic patients without specific recommendations for special populations such as transplant recipients. We developed and implemented a systematic monitoring algorithm for kidney transplant recipients at our transplant center who reported mild symptoms suggestive of COVID-19. We describe the outcomes of the first 44 patients monitored through this algorithm. A total of 44 kidney transplant recipients thought to be symptomatic for COVID-19 disease were followed for a minimum of 14 days. The majority of mildly symptomatic patients (34/44) had clinical progression of disease and were referred to the emergency department where they all tested PCR positive and required hospitalization. More than half of these patients presented with hypoxia requiring supplemental oxygen, 39% were intubated within 48 hours, and 53% developed acute kidney injury but did not require dialysis. There were 6 deaths. During surge outbreaks, kidney transplant patients with even mild symptoms have a high likelihood of COVID-19 disease and most will worsen requiring hospitalization for supportive measures. Earlier outpatient testing and hospitalization may improve COVID-19 outcomes among transplant recipients.
Keywords: COVID-19; coronavirus; kidney transplant; outbreak.
【저자키워드】 COVID-19, coronavirus, outbreak, kidney transplant, 【초록키워드】 coronavirus disease, Hospitalization, hypoxia, hospital, Acute kidney injury, progression, outcome, New York City, Population, dialysis, COVID-19 disease, kidney, Outbreaks, Health, Measures, COVID-19 outbreak, outbreak, symptomatic, healthcare, Algorithm, Patient, Immunocompromised, Guidance, kidney transplant recipient, COVID-19 cases, deaths, 48 hours, Intubated, Mild symptom, recipients, PCR positive, progression of disease, recipient, resources, Public, recommendation, approach, likelihood, IMPROVE, thought, tested, reported, required, majority, mildly symptomatic patient, requiring supplemental oxygen, strained, 【제목키워드】 New York City, management, kidney transplant recipient, Outpatient,