Table 3.
Clinical characteristics of deceased transplant recipients infected by COVID-19
| Reference | Organ | No | Age | Sex | Time since Tx | Comorbities | COVID-19 severity | Radiologic features and relevant labs | Therapeutic approach | Length of hospital stay | Cause of death |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Zhu et al [10] China |
Kidney | 1/10 (10%) | 59 | M | ND | HTN, HHD, COPD | Severe (ICU) | -CT chest: Multiple bilateral ground glass opacities -Significant serum creatinine elevation -Significant decrease in urine volume |
-MPA cessation -CNI cessation -IV MP -IVIG -Antiviral (not specified) -Mechanical Vent. |
6 days | -Acute renal allograft failure -Sudden acute respiratory failure |
| Akalin et al [11] #1* USA |
Kidney | 10/36 (28%) | 60 | M | 5 weeks | None | Mild (home isolation) | ND | MMF cessation | None | -Sudden death |
| Akalin et al [11] #2* USA |
Kidney | 10/36 (28%) | 72 | M | 3 months | DM, HTN | Mild (home isolation | ND | Decrease IS (not specified) | None | -Sudden death |
| Huang et al [18] China |
Liver | 1/1 (100%) | 59 | M | 3 years | History of HBV and HCC | Mild Complicated in day 4 by nosocomial infection | -Chest CT scan showed bilateral ground-glass opacities -Day 4: Marked lung inflammation, blood culture positive for candida albicans, alveolar lavage positive for Ps. |
At admission: lopinavir/ritonavir , piperacillin tazobactam Decrease in MMF, CNI -ECMO at later period - Cefperazone-sulbactam and caspofungin |
45 days | Multiple organ failure |
| TCUKTP [19] #1 USA |
Kidney | 2/15 (13%) | 70 | M | 5 years | ND | Severe | Lymphopenia (500) CRP=100mg/dL IL-6=89.5pg/mL |
Held MPA, postponed belatacept HQ, azithromycin |
ND | Severe acute respiratory distress syndrome |
| TCUKTP [19] #2 USA |
Kidney | 78 | M | 10 years | ND | Severe | CXR: bilateral patchy opacity Lymphocytes=860 CRP=208mg/dL IL-6=10 pg/mL |
Held MMF HQ, azithromycin |
ND | Severe acute respiratory distress syndrome | |
| Periera et al [22] USA |
ND | 16/90 (17.8%) | ND | ND | ND | ND | ND | ND | ND | ND | ND |
| Fernandez-Ruiz et al [23] #1 Spain |
Kidney | 5/18 (27.8%) | 78 | M | 8.3 years | HTN, prostatic adeno-carcinoma | Severe | CXR; Unilateral diffuse consolidation | Lopinavir/ritonavir Reduction of tacrolimus dose High flow O therapy |
5 days | ARDS |
| Fernandez-Ruiz et al [23] #2 Spain |
Kidney | 71 | F | 6 years | HTN | Severe | CXR: Bilateral interstitial pneumonia, patchy consolidations |
Lopinavir/ritonavir HQ, Reduction of tacrolimus dose, discontinuation of MPA and prednisone Metilprednisolone (day +10), IVIg (day +10) |
16 days | ARDS | |
| Fernandez-Ruiz et al [23] #3 Spain | Liver | 72 | M | 5.5 years | HTN, DM, obesity | Severe | CXR: Multifocal consolidation | HCQ (day +1), LPV/r, IFN-β, HFOT, Transitory conversion from MMF to tacrolimus |
7 days | Progressive respiratory failure with ARDS, renal failure, |
|
| Fernandez-Ruiz et al [23] #4 Spain |
Liver | 73 | M | 16.4 years | HBV cirrhosis, diabetes, asthma, bronchiectasis, splenectomy |
Severe (ICU) | CXR: multifocal consolidation | Discontinuation of MMF Mechanical vent. |
24 days | ARDS, refractory shock |
|
| Fernandez-Ruiz et al [23] #5 Spain |
Heart | 63 | M | 17.9 years | IHD,, HTN, DMs, lung cancer, peripheral artery disease | Severe | CXR: bilateral diffuse consolidation | Discontinuation of cyclosporine and MMF LPV/r, HQ, IFN-β (day +6) |
10 days | ARDS | |
| Huang et al24 #1 China |
HSCT | 2/2 (100%) | 51 | M | 2 years | History of acute myeloid leukemia | Severe | Chest CT: multiple patchyground glass opacities bilaterally. Lymphopenia (258) |
Cessation of IS (Cs) LPV/r, MP, Mechanical vent. linezolid, meropenem, and caspofungin for nosocomial infection |
22 days | ARDS |
| Huang et al24 #2 China |
Kidney | 58 | M | 12 years | None | Severe | Chest CT: multiple patchy ground glass opacities Lymphopenia (376) |
Cessation of IS (MMF), LPV/r Methylprednisolone, Mechanical vent. linezolid, meropenem, and caspofungin when nosocomial infection ECMO |
40 days | Multiorgan failure | |
| Bhoori et al25 Italy |
Liver | 3/3 (100%) | >65** | 3M | The 3 cases transplanted more than 10 years ago | The 3 had HTN, DM, obesity | 3 severe | ND | All three patients their IS regimen had been gradually tapered off, with very low trough concentrations of CI (two patients receiving Cs [28 and 35 ng/mL, respectively] and one receiving tacrolimus [2 1ng/mL]). |
3 to 12 days | ARDS in the 3cases |
| Feng et al [26] China |
Lung | 1/3 (33%) | 66 | M | Lung transplanted after COVID-19 infection by 42 days | HTN | Severe | ND | ND | ND | Death post operative by 1 day |
| Alberici et al [27] #1 Italy |
Kidney | 5/20 (25%) | 71 | M | 13 years | IHD | Severe | ND | MMF/CNI/low-dose steroids Dexamethasone |
Overall, patients died after a median of 11 days from admission | ARDS |
| Alberici et al [27] #2 Italy |
57 | M | 2 years | HCV infection | Severe | ND | MMF/CNI/low-dose steroids, combination of lopinavir and ritonavir, HQ, Dexamethasone Tocilizumab | ARDS | |||
| Alberici et al [27] #3 Italy |
59 | M | 5 years | HTN | Severe | ND | MMF/CNI/low-dose steroids, combination of lopinavir and ritonavir, HQ, Dexamethasone | ARDS | |||
| Alberici et al [27] #4 Italy |
70 | F | 16 years | HTN | Severe | ND | MMF/CNI/low-dose steroids, combination of lopinavir and ritonavir, HQ, Dexamethasone | ARDS | |||
| Alberici et al [27] #5 Italy |
63 | M | 16 years | HTN | Severe | ND | MMF/CNI combination of lopinavir and ritonavir, HQ, Dexamethasone Tocilizumab | ||||
| Maggi et al [33] Italy |
Liver | 1/2 (50%) |
69 | M | 30 days | HIV | Severe | ND | ND | ND | ARDS |
| Gandolfini et al [37] Italy |
Kidney | 1/2 (50%) | 75 | M | 10 years | COPD, heart disease, HTN, obesity | Severe | Chest CT: 40% lung involvement CRP=180mg/dL Lymphocytes=880 |
Reduction of MMF and CNI dose lopinavir and ritonavir, HQ Antibiotics |
5 days | ARDS |
| Banerjee et al [38] UK |
Kidney | 1/7 (14%) | 76 | F | 1 year | DM, HTN | Severe (ICU) | CXR: revealed bilateral patchy consolidation Lymphocyts=800 CRP=83mg/dL d-dimer>6000µg/l |
MMF stopped, CNI reduced Mechanical ventilator Antibiotics |
12 days | ARDS, AKI |
| Nair et al [40] #1 USA |
Kidney | 3/10 (30%) | 56 | M | 20 years | DM, HTN | Severe (ICU) | CXR: multifocal patchy opacity Lymphocyts=320 CRP=30.6mg/dL Ferritin=2871ng/mL |
Cessation of MMF and CNI HQ, azithromycin, ceftriaxone Mechanical vent. |
5days | ARDS AKI |
| Nair et al [40] #2 USA |
74 | F | 8 years | HTN, malignancy (not specified) | Severe (ICU) | CXR: multifocal patchy opacity Lymphocyts=440 Ferritin=817ng/mL |
Machanical vent. Cessation of CNI, HQ, Azithromycin |
21 days | ARDS | ||
| Nair et al [40] #3 USA |
56 | F | 3 years | DM, HTN | Severe (ICU) | CXR: multifocal patchy opacity Ferritin=994ng/mL CRP=23.5mg/dL |
Mechanical vent. Cessation of MMF HQ, azithromycin Levofloxacin, ceftriaxone |
8 days | ARDS | ||
| Abrishami et al [47] Iran |
Kidney | 8/12 (67%) | 32-66 (median 56) | 7M/1F | 3-18 years (median 14.5) |
1 HTN, IHD 7 none |
8 Severe (ICU) |
Lymphopenia (6/8), Elevated CRP (6/8), elevated creatinine (3/8) | ND | ND | 8 ARDS |
| Malard et al [48] France |
HSCT | 1/7 (14%) |
65 | M | ND | HTN | Severe | ND | ND | 17 days | ARDS |
| Montagud-Marrahi et al [49] Spain |
31 Kidney 2 Dual |
2/33 (6%) | 87 72 |
F M |
ND | ND | Both severe (ICU) | ND | ND | 13 days 22 days |
ARDS |
| Holzhauser et al [50] USA |
Heart | 1/2 (50%) |
59 | F | 8 years | DM, HTN, CKD | Severe | CXR: bilateral diffuse bronchial wall thickening and patchy peribronchial ground-glass opacities CRP=110 mg/dL Ferritin 4342ng/mL (day 6) |
HQ, doxycyclin, IVIG, lopinavir/ritonavir CVVHD Heparin drip |
10 days | ARDS AKI |
*Only two from ten patients were reported in details
**This is the age reported in this article
AKI: acute kidney injury; ARDS: acute respiratory distress syndrome; CKD: chronic kidney disease; CNI: calcineurin inhibitor; COPD: chronic obstructive pulmonary disease; CRP: C reactive protein; Cs: cyclosporine; CVVHD: continuous veno‐venous hemodialysis ; CXR: chest x ray; ECMO: extracorporeal membrane oxygenation; F: female; HBV: hepatitis B virus; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; HHD: hypertensive heart disease; HSCT: Haematopoeitic Stem cell Transplant; HFOT: high flow O therapy; HIV: human immunodeficiency virus; HQ: hydroxychloroquine; HTN: hypertension; ICU: intensive care unit; IHD: ischemic heart disease;IS: immunosuppressive; LPV/r: lopinavir/ritonavir; M: male; MMF: mycophenolate mofetil; MP: methylprednisolone; MPA: mycophenolic acid; ND: not determined; Ps: pseudomonas; TCUKTP: The Columbia University Kidney Transplant Program; Tx: transplant