Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know

Arpita Basu; Rachel Patzer; Darya Hosein; Zhensheng Wang; Nitika Sharma; Harold Franch; Frederic Rahbari Oskoui; Divya Gupta; Ram Subramanian; Lakshmi Sridharan; Wanda Allison; Stephen Pastan; Christian Larsen

doi:10.1097/TXD.0000000000001074

Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know

Transplant Direct. 2020 Nov 16;6(12):e633. doi: 10.1097/TXD.0000000000001074. eCollection 2020 Dec.

Affiliations

¹ Emory Transplant Center, Emory University School of Medicine, Atlanta, GA.
² Division of Nephrology and Hypertension, Emory University School of Medicine, Atlanta, GA.

Abstract

Background: The current surge of coronavirus 2019 (COVID-19) cases in certain parts of the country has burdened the healthcare system, limiting access to tertiary centers for many. As a result, COVID-19-positive Solid Organ Transplant (SOT) recipients are increasingly being managed by local healthcare providers. It is crucial for community providers to understand disease severity and know if COVID-19-impacted SOT recipients have a different clinical course compared with COVID-19-negative SOT recipients with a similar presentation.

Methods: We conducted a retrospective analysis on SOT recipients suspected to have COVID-19 infection tested during March 14, 2020-April 30, 2020. Patients were followed from time of testing to May 31, 2020.

Results: One hundred sixty SOT recipients underwent testing: 22 COVID-19 positive and 138 COVID-19 negative. COVID-19-positive patients were more likely to have rapid progression of symptoms (median 3 vs 6 d, P = 0.002), greater hospitalizations (78% vs 64%, P < 0.017), and need for intensive care unit care (45% vs 17%, P < 0.001) Severe COVID-19 infection was not observed in patients on Belatacept for immunosuppression (30% vs 87%,P = 0.001). COVID- 19 positive patients in the intensive care unit were more likely to have multifocal opacities on radiological imaging in comparison to those admitted to the medical floor (90% vs 11%). Survival probability was similar in both cohorts.

Conclusion: COVID-19-infected SOT recipients have a propensity for rapid clinical decompensation. Local providers need to be work closely with transplant centers to appropriately triage and manage COVID-19 SOT recipients in the community.