Table 1.
SOT | Author [reference] | Location | No. of Cases (n) | Age and Sex | Comorbidities | Immunosuppressive Regimen |
Time From Transplant | Initial Presentation (Symptoms) | Treatment | Clinical Course | Outcomes | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Multiple SOT types | Tschopp et al [18] | Switzerland | 21 Kidney (48%) Liver (24%) >1 organ (14%) Pancreas (5%) Lung (5%) Heart (5%) |
Median 56 years 71% male |
HTN (67%) DM (43%) Obesity (24%) |
Tac (86%) Prednisone (43%) MMF (17%) CSA (10%) Aza (10%) mTOR (5%) |
Median 47 months |
Fever (76%), dry cough (57%), nausea (33%) and diarrhea (33%). |
Immunosuppressant modified in 14 pts (67%); HCQ, azithromycin lopinavir/ritonavir |
20 pts (95%) admitted 5 pts (25%) to ICU |
16 pts (80%) discharged 3 pts (15%) remain hospitalized 2 pts (10%) died |
|
Fernández-Ruiz et al [11] | Spain | 18 Kidney (44%) Liver (33%) Heart (22%) |
Median 71 years 77% male |
HTN (72%) DM (50%) Cirrhosis (28%) Obesity (11%) |
Prednisone (67%) MMF/MPA (61%) Tac (56%) EVE (22%) CSA (17%) Aza (6%) mTOR (6%) |
Median 9.3 years |
Fever (83%), gastrointestinal symptoms (28%), respiratory failure (28%) | Lopinavir/ritonavir ± HCQ (50%) HCQ monotherapy (28%) Interferon-β (17%) |
2 pts (11%) required ICU and invasive mechanical ventilation 4 pts (22%) developed progressive respiratory failure 1 (6%) pt had improvement in condition |
5 pts died (28%) 5 pts (28%) remain hospitalized 8 pts (44%) discharged |
||
Pereira et al [8] | United States | 90 Kidney (51%) Lung (19%) Liver (14%) Heart (10%) Heart-kidney (3%) Liver-kidney (1%) Kidney-pancreas (1%) |
Median 57 years 59% male |
HTN (64%) DM (46%) CKD (63%) Chronic lung disease (19%) Dialysis (6%) Obesity (6%) Cancer (3%) HIV (1%) |
CNI (86%) MMF (72%) Steroid (59%) Aza (4%) Belatacept (6%) IVIG ± pheresis (3%) mTOR (7%) |
Median 6.64 years | Fever (70%), cough (59%), dyspnea (43%), fatigue (28%), myalgias (24%), diarrhea (31%) | Immunosuppressant held or reduced in majority of hospitalized pts HCQ (91%) Azithromycin (66%) Remdesivir (3%) Tocilizumab (21%) Bolus steroid (24%) |
22 (24%) required outpatient care 68 pts (76%) admitted; of these, 27 (30%) had severe disease requiring intubation or admission to ICU |
16 pts (18%) died 37 pts (54%) discharged |
||
Travi et al [19] | Italy | 13 Liver (54%) Kidney (31%) Heart/kidney (15%) |
Median 59 years 69% male |
HTN (54%) DM (31%) |
Tac (54%) CSA (38%) MMF (38%) Steroid (46%) Belatacept (8%) |
Median 5.3 years | Respiratory symptoms | 62% had reduction or change to immunosuppressant medication HCQ (62%) HCQ + lopinavir/ritonavir (23%) Remdesivir (8%) High-dose steroids (23%) Tocilizumab (15%) |
69% developed respiratory failure | 1 pt died | ||
Fung et al [20] | United States | 10 Kidney (70%) 7 Lung (10%) 1 Heart (10%) 1 Liver (10%) 1 |
Median 56.5 years 60% male 6 |
HTN, DM, cardiovascular disease | Triple immunosuppression (70%) 7 |
Median 6.1 years |
Fever (80%), cough (80%), dyspnea (80%), myalgia (60%), fatigue (50%) | Immunosuppressive medications decreased in 8 (80%) 2 (20%) enrolled in RCT 3 (30%) with either HCQ, azithromycin, lopinavir/ritonavir, 7 (70%) abx |
70% hospitalized 30% required ICU admission; all developed ARDS and shock |
5 pts (50%) discharged 2 pts (20%) remain hospitalized |
||
Hoek et al [21] | Netherlands | 23 Kidney (65%) 15 Heart (13%) 3 Lung (13%) 3 Liver (4%) 1 Kidney-heart (4%) 1 |
Mean 59 years 78% male 18 |
HTN (83%) 19, DM (43%) 10, obese (22%) 5 | CNI + MMF (61%) 14 CNI, MMF + steroid (26%) 6 Steroid (4%) 1 EVE (4%) 1 |
<1 year (4%) >1 year (96%) |
Fever (81%) 19, cough (71%) 16, dyspnea (59%) 14 |
57% remained on immunosuppressive medications 13 All hospitalized pts received abx HCQ (13%) 3 |
83% required hospitalization 19 13% monitored at home without additional treatment 3 2 pts (9%) admitted to ICU requiring ventilation |
5 (22%) died 14 (61%) recovered and discharged 4 (17%) with clinical improvement |
||
Hsu et al [22] | Los Angeles, CA | 1 heart/kidney | 39 years, male | DM, HTN, obesity, chronic foot ulcer | Tac, MMF, prednisone | 3 years | Fever, headache, sore throat, dry cough, dyspnea, fatigue, myalgias | HCQ Enrolled in clinical trial |
Tac, prednisone, continued for entirety of illness course, MMF held starting SD 4 Presented to ED on SD 2; home quarantine SD 3; worsening symptoms and hospitalization SD 4, discharge SD 5; readmission SD 8; worsening hypoxia and transfer to ICU ID 9; transferred out of ICU; discharged SD 15 |
Alive, discharged | ||
Yi et al [23] | Houston, TX | 21 Kidney (57%) 12 Liver (14%) 3 Lung (10%) 2 Heart-lung (5%) 1 Liver-kidney (5%) 1 Heart-kidney (5%) 1 Kidney-pancreas (5%) 1 |
Mean 54.8 years 62% male 13 |
90% with either HTN, DM, obesity, chronic lung disease, CVD | Triple immunosuppression (81%) 17 |
Median of 5.58 years | 95% with fever, cough SOB 20 43% with diarrhea, vomiting, abdominal pain 9 |
Immunosuppressive medications adjusted daily based on organ type Azith ± HCQ, tolicuzimab remdesivir, ribavirin |
33% treated as outpatients 7 67% hospitalized 14 50% hospitalized pts admitted to the ICU, 36% of hospitalized requiring ventilatory support 7 ICU, 5 vent |
1 pt (5%) died (heart-kidney) 4 (19%) remain in ICU 6 (29%) discharged |
||
Heart SOT | Holzhauser et al [24] | United States | 2 | Pt 1: 59 years/female Pt 2: 75 years/male |
Pt 1: HTN, DM, CKD Pt 2: HTN, DM, CKD, and CAV |
Pt 1: Tac, MPA Pt 2: CSA, MMF |
Pt 1: 8 years Pt 2: 20 years |
Pt 1: Fever, myalgia, fatigue, diarrhea, productive cough Pt 2: Fever, cough, diarrhea, fatigue, anorexia |
Pt 1: Cefepime, vancomycin, oseltamivir, HCQ, tocilizumab, doxycycline, IVIG, lopinavir/ritonavir, micafungin, SMZ-TMP, tobramycin, linezolid Immunosuppressants held Pt 2: HCQ, tocilizumab, methylprednisolone MMF held |
Pt 1: Respiratory failure, renal failure, and ARDS requiring intubation Pt 2: Required noninvasive respiratory support; clinical improvement over course of hospitalization |
Pt 1: Died Pt 2: Alive, discharged |
|
Li et al [25] | China | 2 | Pt 1: 51 years/male Pt 2: 43 years/male |
Pt 1: HTN Pt 2: Hyperlipidemia, IGT |
Pt 1: Tac, MMF Pt 2: Tac, MMF |
Pt 1: 17 years Pt 2: 3 years |
Pt 1: Fever, chills, fatigue, anorexia, diarrhea Pt 2: Fever |
Pt 1: Levofloxacin ribavirin, moxifloxacin, ganciclovir, IVIG, methylprednisolone, Umifenovir Pt 2: Ceftriaxone, ganciclovir, moxifloxacin, Umifenovir |
Pt 1: Hospital admission MMF and Tac held 5 days Pt 2: Home quarantine followed by hospitalization for 5 days |
Pt 1: Alive, discharged Pt 2: Alive, discharged |
||
Russell et al [26] | United States | 1 | 3 years/female | EBV | Tac | 25 months | Productive cough, rhinorrhea, nasal congestion | IVIG | Hospital admission; remained clinically stable with mild clinical course | Alive, discharged | ||
Latif et al [27] | United States | 28 | Median 64 years 79% male |
HTN (71%) DM (61%), CAV (57%) Obesity (25%) |
CNI (96%), MMF (68%) Steroid (68%) Sirolimus/EVE (18%) |
Median 8.6 years | Fever (83%), dyspnea/cough (91%), gastrointestinal symptoms (48%) | 22 pts (79%) had change in immunosuppressant medications on hospitalization HCQ (78%), High-dose steroid (47%) IL-6-ra (26%) |
6 pts (21%) managed outpatient 22 pts (79%) hospitalized 7 pts (25%) required mechanical ventilation |
7 admitted pts (25%) died 11 admitted pts (50%) discharged 4 admitted pts (18%) remain hospitalized |
||
Kidney SOT | Alberici et al [28] | Italy | 20 | Not reported | Not reported | Not reported | Not reported | Not reported | HCQ (95%) Dexamethasone (55%) Tocilizumab (30%) |
4 pts (20%) admitted to ICU | 5 pts (25%) died 3 pts (15%) discharged |
|
Banerjee et al [29] | England | 7 | Median age 54 years (range, 45-69) Pt 1: 48/male Pt 2: 67/female Pt 3: 54/female Pt 4: 65/male Pt 5: 69/female Pt 6: 54/male Pt 7: 45/male |
Pt 1: HTN Pt 2: DM, HTN Pt 3: Post-transplant diabetes mellitus, CMV Pt 4: HTN, wheelchair bound Pt 5: DM, HTN Pt 6: HTN, hemolytic anemia Pt 7: HTN |
Pt 1: Aza, prednisolone Pt 2: Tac, MMF, prednisolone Pt 3: Tac, MMF, prednisolone Pt 4: Tac, MMF, prednisolone Pt 5: Tac, MMF, prednisolone Pt 6: Tac, MMF Pt 7: Tac, Aza, prednisolone |
Pt 1: 31 years Pt 2: 1 year Pt 3: 3 months Pt 4: 2 years Pt 5: 2 months Pt 6: 7 years Pt 7: 3 years (second transplant) |
Respiratory symptoms (cough, shortness of breath) and fever Pt 5 presented with respiratory symptoms, fever plus vomiting and diarrhea |
Pt 1: Aza, prednisolone continued Pt 2: MMF stopped; Tx with broad-spectrum abx in ICU; Tac d/c 1 day before death Pt 3: Tac and MMF stopped; Tx with broad-spectrum abx, oseltamivir; Empiric tx for pneumocystis with high-dose cotrimoxazole Pt 4: MMF stopped Pt 5: MMF stopped; Tx with doxycycline, piperacillin-tazobactam, paracetamol, furosemide, and blood transfusion Pt 6: MMF stopped Pt 7: Aza stopped, Tac dose reduced, prednisolone dose increased |
Pt 1: Remained at home Pt 2: Hypoxic, transferred to ICU, required ventilation; developed AKI, severe metabolic acidosis Pt 3: Hypoxic on presentation, started on CPAP; rapid deterioration of respiratory status requiring ventilation Pt 4: Admitted to ICU; stepped down to medical ward Pt 5: Brief ICU stay for respiratory support, not intubated; stepped down to ward Pt 6: Developed AKI, continued to remain symptomatic, and MMF stopped Pt 7: Admitted, managed in the ward; developed severe AKI, required one hemodialysis session |
Pt 1: Full recovery Pt 2: Died 12 days after hospitalization Pt 3: Alive, remains on ventilation Pt 4: Alive, requires 4 to 6 L oxygen to maintain saturation Pt 5: Alive, in inpatient ward Pt 6: Stayed at home; alive with continued cough and some flulike symptoms Pt 7: Alive, in inpatient ward |
||
Arpali et al [30] | Turkey | 1 | 28 years/female | Not reported | Tac and prednisone | 6 months | Fever, malaise, sore throat, rhinorrhea | Continued on Tac and prednisone; oseltamivir given at second ED visit | Initially presented to ED, treated with amoxicillin, no SARS-CoV-2 testing done; presented following day to ED with high fever, swabbed for SARS-CoV-2, sent home; 6 days later, testing result positive and returned to hospital to be monitored; discharged after 24 hours | Alive, at home, reports no symptoms | ||
Guillen et al [31] | Spain | 1 | 50 years/male | HTN | Tac, EVE, prednisone | 4 years (third deceased donor transplant) | Fever, vomiting | Ceftriaxone, azithromycin, ceftaroline, meropenem, lopinavir/ritonavir, HCQ, interferon-β, Tac and EVE held due to potential DDI | Presented to ED and discharged with presumptive viral gastroenteritis; presented to ED 5 days later with persistent fever and productive cough, dx with CAP; tested positive for SARS-CoV-2, was placed in isolation; respiratory status worsened, requiring intubation | Remains in ICU with respiratory support | ||
Zhu et al [32] | China | 1 | 52 years/male | Not reported | Tac, MMF, prednisone | 12 years | Fatigue, dyspnea, tightness and chest pain, nausea, loss of appetite, intermittent abdominal pain, occasional dry coughs, fever, headache | Tac, MMF, prednisone discontinued; restarted at full dose 3 days prior to discharge Umifenovir, moxifloxacin, methylprednisolone, IVIG, interferon alpha, carbapenem, pantoprazole |
Presented to fever clinic, laboratory findings and chest CT suggestive of SARS-CoV-2 Symptoms worsened at home and admitted to hospital on SD 8; required oxygen via NC; symptoms improved over course of hospitalization; discharged on SD 21 |
Alive, discharged to home | ||
Marx et al [33] | France | 1 | 58 years/male | Not reported | Belatacept, MMF, prednisone | 3 years | Fever, mild dyspnea, cough | MMF and belatacept discontinued on admission to hospital; CSA started but plan to d/c this and restart MMF and belatacept at next date of infusion | Pt admitted to hospital; treated for possible bacterial superinfection but reported to have mild hospital course | Alive, resolution of fever and respiratory symptoms 5 days after discharge | ||
Gandolfini et al [34] | Italy | 2 | Pt 1: 75 years/male Pt 2: 52 years/female |
Pt 1: COPD, heart disease, HTN, obesity Pt 2: HTN |
Pt 1: Tac, MMF, steroid Pt 2: Tac, MMF, steroid |
Pt 1: 120 months Pt 2: 8 months |
Cough, myalgia, fever, dyspnea | MMF and Tac were discontinued on the day of admission; both patients received hydroxychloroquine and lopinavir/ritonavir or darunavir/cobicistat Pt 2: Colchicine |
Both patients required noninvasive ventilation Pt 1: Abrupt worsening of respiratory conditions and died 5 days after admission Pt 2: Respiratory symptoms worsened and received colchicine; respiratory symptoms improved after drug initiation |
Pt 1: Died Pt 2: Alive, remained on noninvasive ventilation |
||
Akalin et al [35] | United States | 36 | Median of 60 years 72% males |
HTN (94%), DM (70%) History of smoking tobacco or current smokers (36%) CVD (17%) |
Tac (97%) Prednisone (94%) MMF (86%) |
Not reported | Fever (58%), diarrhea (22%) | Of hospitalized pts: Antimetabolite held in 86% Tac held in 21% HCQ (86%) 21% received leronlimab on a compassionate-use basis 7% received tocilizumab |
8 pts (22%) in stable condition were monitored at home 28 pts (78%) were admitted to the hospital; 11 pts (39%) received mechanical ventilation, 6 pts (21%) received renal replacement therapy |
10 (28%) pts died, including 2 pts who had been monitored as outpatients 12 pts (43%) remained hospitalized 10 pts (36%) hospitalized discharged to home |
||
Chen et al [36] | China | 1 | 49 years/male | HTN | Tac, MMF, prednisone | 7 years | Loss of appetite, fever | MMF, Tac, and prednisone held Umifenovir, methylprednisolone, moxifloxacin, IVIG, ribavirin |
Progressive worsening of cough, shortness of breath, hypoxic, fever; required inhaled oxygen and transferred to respiratory intensive care; symptoms gradually improved over course of hospitalization | Alive, discharged to home | ||
Fontana et al [37] | Italy | 1 | 61 years/male | CKD, malignancy, coagulopathy, Parkinson disease | CSA, steroid | 15 years | Fever/chills | CSA held, steroid increased HCQ, tocilizumab, azithromycin, meropenem |
Remained hemodynamically stable throughout hospitalization | Alive, discharged to home | ||
Zhang et al [38] | China | 5 | Mean 45 years 80% male 4 |
HTN (40%), 2 DM (40%), 2 Malignancy (20%), 1 |
MMF, CNI, and steroid (80%) 4 | Range of 2 months to 4 years | Fever (100%), cough (100%), myalgia/fatigue (60%), 3 Sputum (60%) 3 |
Oseltamivir or arbidol (100%) Abx (20%) 1 IVIG (20%) 1 |
Immunosuppressant modified after symptom onset All pts hospitalized; resolution of symptoms in 4 (80%) None required intubation or ICU admission |
2 (40%) discharged 3 (60%) remain hospitalized |
||
Abrishami et al [39] | Iran | 12 | Mean 47.66 years 75% male |
HTN (17%) | All on triple therapy (steroid, CNI/sirolimus, MMF/Aza) | Not reported | Fever (75%), cough (75%), dyspnea (42%) | HCQ, lopinavir/ritonavir, abx (100%) IVIG given if pt hypoxic |
Immunosuppressant modified for all 100% pts hospitalized; 10 (83%) admitted to ICU; 90% in ICU were intubated |
8 (67%) died 4 (33%) discharged |
||
Columbia University Kidney Transplant Program [40] | United States | 15 | Median 51 years 65% male 10 |
Not reported | Tac (93%) 14 MMF/MPA (80%) 12 Prednisone (67%) 10 Belatacept (13%) 2 Leflunomide (7%) 1 Aza (7%) 1 |
Median 49 months | Fever (87%), 13 Cough (60%), 9 Diarrhea (20%), 3 Myalgias (13%) 2 |
93% had immunosuppressant regimen changed 14 HCQ ± azithromycin (87%) 13 Tocilizumab (7%) 1 |
4 (27%) required intubation 6 (40%) developed AKI |
2 (13%) died 8 (53%) discharged 6 (40%) remain hospitalized |
||
Nair et al [41] | United States | 10 | Median 57 years 60% male 6 |
HTN (100%), majority also with DM | Tac + MMF/MPA (90%) 9 Steroid (70%) 7 7 |
Median 7.7 years | Fever, cough, myalgia, fatigue, diarrhea | Hospitalized patients had antimetabolite agent stopped HCQ + azithromycin (100%) Antibiotic (60%) |
90% hospitalized 9 5 (50%) admitted to ICU 5 (50%) developed acute kidney injury. |
3 (30%) died 7 (70%) discharged |
||
Zhu et al [32] | China | 10 | Age between 24 and 65 years 80% male |
HTN, CAD, COPD, atrial fibrillation, HF (60%) | Tac (90%) MMF (90%) Steroid (70%) CSA (10%) Mizoribine (10%) |
6 mo to 12 years | Fever (90%), cough (90%), shortness of breath (90%), fatigue (90%), diarrhea (30%) | Immunosuppressant medication modified in 90% Methylprednisolone (80%) IVIG (70%) Antiviral (100%) |
Mild symptoms in 20% Severe symptoms in 50% Critical symptoms in 30% 100% received NC 30% required noninvasive mechanical ventilation None underwent intubation |
80% recovered 1 (10%) remained hospitalized 1 (10%) died |
||
Machado et al [42] | Brazil | 1 | 69 years/male | HCV, DM, HTN | Tac, MMF, prednisone | 6 years | Fever, fatigue, confusion, diarrhea, decreased urine output | MMF held, Tac decreased, prednisone increased on hospitalization HCQ, nitazoxanide, ceftriaxone, azithromycin |
Developed mild AKI and severe metabolic acidosis; did not require supplemental oxygen; improved over course of hospitalization | Alive, discharged | ||
Kim et al [43] | Korea | 2 | Pt 1: 37 years/male Pt 2: 56 years/male |
Not reported | Pt 1: Tac, MMF, prednisolone Pt 2: Tac, MMF, prednisolone |
Pt 1: 4 years Pt 2: 8 years |
Pt 1: Fever, cough, rhinorrhea, diarrhea, and decreased urine output Pt 2: Asymptomatic |
Pt 1: MMF, tac held; Lopinavir/ritonavir and HCQ Pt 2: MMF held; HCQ with azithromycin |
Pt 1: Improvement in clinical course and kidney function; did not require supplemental oxygen Pt 2: Remained hemodynamically stable with mild symptoms (cough); did not require supplemental oxygen |
Pt 1: Recovered Pt 2: Recovered |
||
Seminari et al [44] | Italy | 1 | 50 years/male | HTN, DM | Tac, MMF | 4 years | Fever, cough | Ceftriaxone | Improvement in clinical course | Alive, discharged | ||
Wang et al [45] | China | 1 | 49 years/male | HTN, DM | CSA, MMF, prednisone | 2 years | Fever, respiratory symptoms | Immunosuppressant medications continued Lopinavir/ritonavir, ribavirin, interferon-α2b, methylprednisolone |
Required supplemental oxygen; respiratory status improved over course of admission | Recovered | ||
Billah et al [46] | United States | 1 | 44years/M | Not reported | Tac, MMF, prednisone | 7 years | Dyspnea | Immunosuppressant medications continued Methylprednisolone |
Developed AKI requiring dialysis; Intubated for respiratory failure | Remains both dialysis and ventilator dependent | ||
Cheng et al [47] | China | 2 | Pt 1: 48 years/male Pt 2: 65 years/female |
Pt 1: Not reported Pt 2: Not reported |
Pt 1: Tac, MMF, prednisone Pt 2: Tac, MMF, prednisone |
Pt 1: 11 years Pt 2: 9 years |
Pt 1: Fever, chest tightness Pt 2: Fever, cough, chest tightness, myalgia |
Pt 1: Immunosuppressant medications held; methylprednisolone Pt 2: Immunosuppressant medications held; moxifloxacin, Umifenovir, IVIG, methylprednisolone |
Pt 1: Symptomatic supportive treatment with improvement in clinical course Pt 2: Respiratory symptoms initially deteriorated; required supplementary oxygen; gradual improvement in clinical course |
Pt 1: Alive, discharged Pt 2: Alive, discharged |
||
Crespo et al [48] | Spain | 16 | Median 73.6 years 75% male 12 |
HTN (88%) 14, DM (50%) 8, heart disease (50%) 8, obesity (44%) 7, malignancy (31%) 5, lung disease (19%) 3 |
CNI (88%) 14 prednisone (81%) 13, MMF (50%) 8, mTOR (31%) 5, TCDA (19%) 3 | Not reported | Fever (100%), dyspnea (75%) 12 myalgia (50%) 8, diarrhea (25%) 4 |
Tac held in 70%, MMF and mTOR held in all 16 Abx (88%), 14 HCQ (81%) 13, steroid (38%) 6 ritonavir-lopinavir/darunavir (31%), 5 tocilizumab (25%) 4 |
15 pts (94%) hospitalized 6 pts (40%) required ICU admission |
8 pts (53%) died | ||
Ning et al [49] | China | 1 | 29 years/male | HTN | MMF, CSA, methylprednisolone | 2 years | Fever/chills, fatigue | Immunosuppressant medications continued SMZ-TMP, moxifloxacin, lopinavir/ritonavir |
Developed oliguria and hyponatremia; clinical course improved over course of admission | Resolution and discharge | ||
Bush et al [50] | United States | 1 | 13 years/male | Chronic severe constipation, rectal prolapse, cecostomy, colostomy with colonic resection | Sirolimus, MMF | 6 years | Rhinorrhea, cough, fever | MMF and sirolimus reduced Antibiotics |
Required NC; remained hemodynamically stable | Alive, discharged to home | ||
Kumar et al [51] | United States | 1 | 50 years/male | HIV, HTN, asthma, steatohepatitis | Tac, MMF | 14 months | Fever/chills, nasal congestion, cough | Not reported | Not admitted, enrolled in COVID home monitoring program | Health improved to baseline | ||
Liver SOT | Maggi et al [52] | Italy | 2 | Pt 1: 61 years/male Pt 2: 69 years/M |
Pt 1: Not reported Pt 2: HIV |
Basiliximab, prednisolone, and Tac | Pts developed SARS-CoV-2 infection during hospitalization for transplant | Pt 1: Fever POD 9 Pt 2: Not reported |
Not reported | Pt 1: Presented with fever POD 9 but with normal chest x-ray findings Pts 2: Tested positive for SARS-CoV-2 on POD 22 |
Pt 1: Alive Pt 2: Died on POD 30 |
|
Bhoori et al [53] | Italy | 3 | >65 years/male | HTN, hyperlipidemia, DM (100%) | CSA (67%) Tac (33%) |
>10 years | Respiratory symptoms similar to CAP | Not reported | 100% required supplementary oxygen at admission but rapidly developed severe respiratory distress syndrome that required mechanical ventilation | 100% died between 3 and 12 days after the onset of pneumonia Authors report 3 recently (within last 2 years) transplanted patients with positive test result for SARS-CoV-2 (on full imuunosuppression); all experienced uneventful course of disease (no further details about this cohort provided) |
||
D’Antiga et al [54] | Italy | 3 | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | None developed clinical pulmonary disease | Not reported | ||
Qin et al [55] | China | 1 | 37 years/male | Not reported | Tac, glucocorticoid | Pt developed SARS-CoV-2 infection during hospitalization for transplant | Fever following chemoembolization on day 3 of hospitalization; persistent fever noted 2 days after transplant (transplant occurred on day 7 of hospitalization) | Osteltamivir, rh-GCSF, IVIG started after confirmation of infection Tac and glucocorticoids titrated to lower dose and then increased on day 40 of hospitalization given concerns for acute cellular rejection |
Presented with fever following hepatic arterial chemoembolization; continued to have persistent fever 2 days following embolization; RT-PCR confirmed infection; fever subsided on day 33 of hospitalization | Alive, discharged to home | ||
Lagana et al [56] | United States | 1 | 6 months/female | Not reported | Not reported | Pt developed SARS-CoV-2 infection during hospitalization for transplant | Respiratory distress, fever, diarrhea Notably, donor tested positive on POD 2 (symptoms not reported) |
HCQ | Fever with increased work of breathing on POD 4; admitted to ICU | Pt remained in hospital with mild respiratory symptoms | ||
Huang et al [57] | China | 1 | 59 years/male | Hepatitis B | Tac, MMF | 3 years | Fever, cough, chills, fatigue, diarrhea, jaundice, ascites, splenomegaly | Nebulized α-interferon, umifenovir, lopinavir/ritonavir, methylprednisolone, albumin, blood, plasma, IVIG; multiple antimicrobials, including caspofungin, voriconazole, piperacillin tazobactam, cefoperazone -sulbactam, meropenem Tac and MMF dosages halved due to DDI with lopinavir/ritonavir |
Respiratory failure on day 4 of hospitalization, placed on NC; hypoxemia worsened requiring intubation; on day 12, blood cx positive for Candida, pleural fluid positive for Pseudomonas; ECMO on day 15 due to worsened respiratory status; condition deteriorated to multiorgan failure | Pt died on day 45 of admission | ||
Bin et al [58] | China | 1 | 50 years/male | Not reported | Tac | 3 years | Fever | Umifenovir, lopinavir/ritonavir, methylprednisolone, IVIG, alpha interferon, antibiotics Tac held on admission to hospital; increased to full dose on discharge |
Pt became progressively dyspneic requiring NC on day 5 of hospitalization; symptoms resolved on day 21; discharged after 4 weeks of hospitalization | Alive, at home | ||
Lee et al [59] | United States | 38 | Median 60 years | For hospitalized pts (n = 24): CKD (71%) 17 HTN (71%), 17 DM (50%), 12 cardiovascular disease (42%), 10 obesity (42%),10 |
For hospitalized pts (n = 24): Tac (96%) 23 CSA (4%) 1 MPA (54%) 13 Steroid (50%) 12 |
Not reported | Gastrointestinal symptoms (42%) 10 | Immunosuppression was decreased in 79% of hospitalized patients 19 18 (75%) received HCQ + azithromycin 5 (21%) received glucocorticoid 8 (33%) received anticoagulant |
63% hospitalized 18 (75%) required supplemental oxygen 8 (33%) required mechanical ventilation |
7 (29%) died 3 (13%) remain hospitalized 14 (58%) discharged |
||
Patrono et al [60] | Italy | 10 | Pt 1: 69 years/male Pt 2: 59 years/male Pt 3: 56 years/male Pt 4: 58 years/male Pt 5: 64 years/female Pt 6: 64 years/male Pt 7: 64 years/male Pt 8: 62 years/male Pt 9: 75 years/male Pt 10: 85 years/female |
Pt 1: None Pt 2: Obesity Pt 3 through Pt 10: Not reported |
Pt 1: MMF, Tac, prednisone Pt 2: Tac, EVE Pt 3: Tac, EVE Pt 4: MMF, Tac, prednisone Pt 5: Tac, prednisone Pt 6: MMF, Tac Pt 7: MMF, Tac Pt 8: MMF, Tac Pt 9: MPA, Tac Pt 10: Tac |
Pt 1: 5 days Pt 2: 8 months Pt 3: 3 years Pt 4: 2 months Pt 5: 4 years Pt 6: 8 years Pt 7: 9 years Pt 8: 11 years Pt 9: 11 years Pt 10: 22 years |
Pt 1: Cough Pt 2: Fever, diarrhea, dyspnea Pt 3: Fever, odonyphagia, cough Pt 4: Asymptomatic Pt 5: Fever, anorexia, diarrhea Pt 6: Fever Pt 7: Fever Pt 8: Fever Pt 9: Fever, diarrhea, myalgia, cough Pt 10: Asymptomatic |
6 patients were administered HCQ, 3 high-dose steroids, and 2 antivirals (lopinavir/ritonavir and darunavir/ritonavir) 6 patients were administered HCQ, 3 high-dose steroids and 2 antivirals (lopinavir/ritonavir and darunavir/ritonavir) 6 (60%) HCQ, 3 (30%) high dose steroids, 2 (20%) antivirals |
Pt 1: Asymptomatic Pt 2: Required supplemental oxygen; gradual symptom improvement Pt 3: Mild symptoms followed by dyspnea requiring supplemental oxygen; clinical course improved Pt 4: Tested positive 2 months after discharge for transplant Pt 8: Contracted infection during hospitalization for head trauma Pt 10: Incidentally found to be positive Pt 5-7, 9: Not reported |
Pt 1: Alive Pt 2: Alive Pt 3: Alive Pt 4: Alive Pt 5: Alive Pt 6: Alive Pt 7: Alive Pt 8: Died (unrelated to SARS-CoV-2) Pt 9: Died Pt 10: Alive |
||
Hammami et al [61] | United States | 1 | 63 years/male | ESRD, DM, HTN, HF, PVD | Tac | 10 years | Fever, dry cough, fatigue, headache | HCQ, ceftriaxone, azithromycin, cefepime, vancomycin, tocilizumab | Waxing and waning fever; day 10 of hospitalization developed pleuritic chest pain and severe periumbilical pain, with improvement after tocilizumab; remained afebrile thereafter | Alive | ||
Modi et al [62] | United States | 1 | 32 years/male | HIV | Tac, MMF, prednisone | 7 years | Fatigue, fever, headache, dry cough | MMF held, Tac reduce, prednisone continued HCQ |
Admitted with mild symptoms which gradually improved over course of hospitalization | Discharge home | ||
Morand et al [63] | France | 1 | 4 years/female | EBV | Tac | 5 months | Rhinitis, fever, cough | Tac dose reduced Antipyretic |
Improvement in clinical symptoms during hospitalization | Recovered |
Abbreviations: Abx, antibiotics; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; Aza, azathioprine; CAD, coronary artery disease; CAP, community-acquired pneumonia; CAV, cardiac allograft vasculopathy; CNI, calcineurin inhibitor; CMV, cytomegalovirus; CPAP, continuous positive airway pressure; CSA, cyclosporine; Cx, culture; CMV, cytomegalovirus; CVD, cardiovascular disease; Dx, diagnosis; d/c, discontinued; DDI, drug–drug interaction; DM, diabetes mellitus; EBV, Epstein-Barr virus; ED, emergency department; ESRD, end-stage renal disease; EVE, everolimus; HCQ, hydroxychloroquine; HCV, hepatitis C virus; HF, heart failure; HIV, human immunodeficiency virus; HTN, hypertension; ICU; intensive care unit; IGT, impaired glucose tolerance; IL-6-ra, interleukin 6 receptor antagonist; IVIG, intravenous immunoglobulin; MMF, mycophenolate mofetil; MPA; mycophenolate acid; mTOR, mammalian target of rapamycin; NC, nasal cannula; Pt(s), patient(s); POD, postoperative day; PVD, peripheral vascular disease; RCT, randomized controlled trial; rh-GCSF, recombinant human granulocyte colony-stimulating factor; SD, symptom day; SMZ-TMP; sulfamethoxazole-trimethoprim; Tac, tacrolimus; TCDA, T-cell–depleting agents; Tx, treatment.