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1.
Front Immunol ; 13: 853682, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35493446

RESUMO

The antibody and T cell responses after SARS-CoV-2 vaccination have not been formally compared between kidney and liver transplant recipients. Using a multiplex assay, we measured IgG levels against 4 epitopes of SARS-CoV-2 spike protein and nucleocapsid (NC) antigen, SARS-CoV-2 variants, and common coronaviruses in serial blood samples from 52 kidney and 50 liver transplant recipients undergoing mRNA SARS-CoV-2 vaccination. We quantified IFN-γ/IL-2 T cells reactive against SARS-CoV-2 spike protein by FluoroSpot. We used multivariable generalized linear models to adjust for the differences in immunosuppression between groups. In liver transplant recipients, IgG levels against every SARS-CoV-2 spike epitope increased significantly more than in kidney transplant recipients (MFI: 19,617 vs 6,056; P<0.001), a difference that remained significant after adjustments. Vaccine did not affect IgG levels against NC nor common coronaviruses. Elicited antibodies recognized all variants tested but at significantly lower strength than the original Wuhan strain. Anti-spike IFN-γ-producing T cells increased significantly more in liver than in kidney transplant recipients (IFN-γ-producing T cells 28 vs 11 spots/5x105 cells), but this difference lost statistical significance after adjustments. SARS-CoV-2 vaccine elicits a stronger antibody response in liver than in kidney transplant recipients, a phenomenon that is not entirely explained by the different immunosuppression.


Assuntos
COVID-19 , Transplante de Fígado , Vacinas Virais , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Epitopos , Humanos , Imunoglobulina G , Rim , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus
2.
Preprint em Inglês | medRxiv | ID: ppmedrxiv-22274524

RESUMO

We aimed to describe the outcomes of Omicron infection in kidney transplant recipients (KTR), compare the efficacy of the community therapeutic interventions and report the safety profile of molnupiravir. From 142 KTRs diagnosed with COVID-19 infection after Omicron had become the dominant variant in the UK, 116 (78.9%) cases were diagnosed in the community; 47 receiving sotrovimab, 21 molnupiravir and 48 no treatment. 10 (20.8%) non-treated patients were hospitalised following infection, which was significantly higher than the sotrovimab group (2.1%), p=0.0048, but not the molnupiravir treated group (14.3%), p=0.47. The only admission following sotrovimab occurred in a patient infected with BA.2. One patient from the molnupiravir and no-treatment groups required ICU support, and both subsequently died, with one other death in the no-treatment group. No patient receiving sotrovimab died. 6/116 (5.2%) patients required dialysis following their diagnosis; 2 (9.5%) patients receiving molnupiravir and 4 (8.3%) no-treatment. This requirement was significantly higher in the molnupiravir group compared with the sotrovimab treated patients, in whom no patient required dialysis, p=0.035. Both molnupiravir treated patients requiring dialysis had features of systemic thrombotic microangiopathy. Post-vaccination serostatus was available in 110 patients. Seropositive patients were less likely to require hospital admission compared with seronegative patients, 6 (7.0%) and 6 (25.0%) respectively, p=0.023. Seropositive patients were also less likely to require dialysis therapy, p=0.016. In conclusion, sotrovimab treatment in the community was associated with superior patient and transplant outcomes; its clinical efficacy against the BA.2 variant requires a rapid review. The treatment benefit of molnupiravir was not evident, and wider safety reporting in transplant patients is needed.

3.
Preprint em Inglês | medRxiv | ID: ppmedrxiv-22274396

RESUMO

BackgroundSolid organ transplant recipients have attenuated immune responses to SARS-CoV-2 vaccines. In this study, we report on immune responses to 3rd- (V3) and 4th- (V4) doses of heterologous and homologous vaccines in a kidney transplant population. Methods724 kidney transplant recipients were prospectively screened for serological responses following 3 primary doses of a SARS-CoV2 vaccine. 322 patients were sampled post-V4 for anti-spike (anti-S), with 69 undergoing assessment of SARS-CoV-2 T-cell responses. All vaccine doses were received post-transplant, only mRNA vaccines were used for V3 and V4 dosing. All participants had serological testing performed post-V2 and at least once prior to their 1st dose of vaccine. Results586/724 (80.9%) patients were infection-naive post-V3; 141/2586 (24.1%) remained seronegative at 31 (21-51) days post-V3. Timing of vaccination in relation to transplantation, OR: 0.28 (0.15-0.54), p=0.0001; immunosuppression burden, OR: 0.22 (0.13-0.37), p<0.0001, and a diagnosis of diabetes, OR: 0.49 (0.32-0.75), p=0.001, remained independent risk factors for non-seroconversion. Seropositive patients post-V3 had greater anti-S if primed with BNT162b2 compared with ChAdOx1, p=0.001. Post-V4, 45/239 (18.8%) infection-naive patients remained seronegative. De novo seroconversion post-V4 occurred in 15/60 (25.0%) patients who were seronegative post-V3. There was no difference in anti-S post-V4 by vaccine combination, p=0.50. Anti-S post-V4 were sequentially greater in those seroconverting post V2- compared with V3-, and V3- compared with V4-, at 1561 (567-5211), 379 (101-851) and 19 (9.7-48) BAU/ml respectively. T-cell responses were poor, with only 11/54 (20.4%) infection-naive patients having detectable T-cell responses post-V4, with no difference seen by vaccine type. ConclusionA significant proportion of transplant recipients remain seronegative following 3- and 4- doses of SARS-CoV-2 vaccines, with poor T-cell responses, and are likely to have inadequate protection against infection.

4.
Preprint em Inglês | medRxiv | ID: ppmedrxiv-22274980

RESUMO

The neutralizing monoclonal antibody combination of tixagevimab/cilgavimab has been shown to reduce the risk of SARS-CoV-2 infection in unvaccinated individuals during the Alpha (B.1.1.7) and Delta (B.1.617.2) waves. However, data on efficacy and safety of tixagevimab/cilgavimab in vaccinated solid organ transplant recipients during the Omicron wave is limited. To address this, we conducted a retrospective cohort study comparing 222 solid organ transplant recipients who received tixagevimab/cilgavimab for pre-exposure prophylaxis and 222 age-matched vaccinated solid organ transplant recipients who did not receive tixagevimab/cilgavimab. Subjects were followed for a mean of 67 {+/-} 18 days. Kaplan-Meier estimates of the 60-day incidence of breakthrough infection were 1.8% in the tixagevimab/cilgavimab group and 4.7% in the control group (P = 0.045). Adverse events were uncommon, occurring in 4% of our cohort and most were mild. There was no significant change in serum creatinine or liver chemistries in kidney and liver transplant recipients respectively. In conclusion, we found that tixagevimab/cilgavimab use is safe and associated with a lower risk of breakthrough SARS-CoV-2 infection in vaccinated solid organ transplant recipients during the Omicron wave.

5.
Preprint em Inglês | medRxiv | ID: ppmedrxiv-22275056

RESUMO

While SARS-CoV-2 mRNA vaccination has been shown to be safe and effective in the general population, immunocompromised solid organ transplant recipients (SOTR) were reported to have impaired immune responses after one or two doses of vaccine. In this study, we examined humoral responses induced after the second and the third dose of mRNA vaccine in different SOTR (kidney, liver, lung and heart). Compared to a cohort of SARS-CoV-2 naive immunocompetent health care workers (HCW), the second dose induced weak humoral responses in SOTR, except for the liver recipients. The third dose boosted these responses but they did not reach the same level as in HCW. Interestingly, while the neutralizing activity against Delta and Omicron variants remained very low after the third dose, Fc-mediated effector functions in SOTR reached similar levels as in the HCW cohort. Whether these responses will suffice to protect SOTR from severe outcome remains to be determined.

6.
Clin Nephrol ; 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35575426

RESUMO

BACKGROUND: Transplanting kidneys from donors with a recent history of severe SARS-CoV-2 pneumonia is uncommon due to concerns about the risk of viral transmission and the quality of kidneys from these donors. To date, there are no conclusive data on viral transmission from extrapulmonary solid organ transplants. Given the prevalence of SARS-CoV-2 infections in potential donors, shortage of kidneys available for transplantation, and low risk of viral transmission, we developed a clinical protocol for accepting kidneys from donors with recent severe SARS-CoV-2 pneumonia who demonstrate preserved kidney function. MATERIALS AND METHODS: We collected data on early outcomes of 5 kidney transplant recipients from 4 deceased donors hospitalized for severe SARS-CoV-2 infection. RESULTS: Donor creatinine ranged from 0.51 to 0.60 mg/dL and kidney donor profile index (KDPI) from 14 to 52%. Three of the five kidneys were from donation after circulatory death. All recipients were fully vaccinated, and 4/5 received post-exposure prophylactic monoclonal antibody treatment. While 3 recipients had delayed graft function, all had excellent graft function at 3 or 4 weeks post-operatively. None of the recipients displayed signs or symptoms of SARS-CoV-2 infection post-transplant. CONCLUSION: Our findings suggest that kidney grafts from donors with a recent history of severe SARS-CoV-2 infection but with preserved kidney function can be safely used and have good early outcomes.

7.
Nefrologia ; 2022 Apr 30.
Artigo em Espanhol | MEDLINE | ID: mdl-35528867

RESUMO

INTRODUCTION: SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated. OBJECTIVES: Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis. MATERIAL AND METHODS: Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis. RESULTS: 615 renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years.The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased.Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7±0.8, 2.1±1.2 and 1.8±1 mg/dl respectively (p<0.001).56.9% of the patients (N=350) were monitored for anti-HLA antibodies. 94% (N=329) had no anti-HLA changes, while 6% (N=21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N=9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant. CONCLUSIONS: The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.

8.
Transpl Infect Dis ; 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35505522

RESUMO

BACKGROUND: Heart transplant (HTx) recipients are at increased risk of developing infections or malignancies due to immunosuppressive medication. Thus, regular aftercare in those patients is of utmost importance. The extent of collateral damage due to the COVID-19 pandemic (delayed or canceled clinical visits and diagnostics) on high-risk patients is yet unknown. We believe that, especially for HTx-patients, data acquisition on potential pandemic-related non-attendance is crucial to improve clinical care in the future. Therefore, we aim to decipher possible COVID-19-related alterations in attendance to clinical care post-HTx using a survey-based approach. METHODS: HTx recipients two years beyond transplantation were selected (n = 75). We filed a paper-based questionnaire or an online survey containing nine items about COVID-19 related exceptional circumstances. Fifty-two patients (69%) returned fully answered questionnaires. RESULTS: A perceived impact on daily life was evident with 79% of all patients reporting moderate to severe negative influence of COVID-19 pandemic on daily routine. We detected increased non-attendance of clinical care during the COVID-19 pandemic compared to pre-pandemic time (38% vs. 6%, p<0.0001). The various diagnostic modalities of aftercare were heterogeneously affected, ranging from 2% non-attendance for influence vaccination and 18% for colonoscopy. Off note, non-attendance to clinical care within the pandemic was independent of perceived impact of the pandemia on daily life (p>0.68). CONCLUSIONS: For the first time, we objectively demonstrate significant decrease in attendance to clinical care in HTx recipients during COVID-19 pandemic. Efforts are needed to increase attendance in this highly vulnerable patient cohort. This article is protected by copyright. All rights reserved.

9.
Am J Transplant ; 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578576

RESUMO

Limited data exists on the effectiveness of a third COVID-19 vaccine dose in solid organ transplant recipients. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada to answer this question. We included solid organ transplant recipients (n=12,842) as of December 14, 2020, with follow-up until November 28, 2021. We used an extended Cox proportional hazards model with vaccination status, including BNT162b2, mRNA-1273 and ChAdOx1 vaccines, modelled as a time-dependent exposure. Individuals started in the unvaccinated category (reference) and could contribute person-time to first, second and third doses. Over a median follow-up of 349 days, 12.7% (n=1632) remained unvaccinated, 54.1% (n=6953) received 3 doses, and 488 (3.8%) tested positive for SARS-CoV-2, (of which 260 [53.3%] had a clinically important outcome [i.e., hospitalization or death]). Adjusted vaccine effectiveness against infection was 31% (95% CI: 2, 51%), 46% (95% CI: 21, 63%), and 72% (95% CI: 43, 86%) for one, two, and three doses. Vaccine effectiveness against clinically important outcomes was 38% (95% CI: 4, 61%), 54% (95% CI: 23, 73%) and 67% (95% CI: 11, 87%). Vaccine effectiveness in solid organ transplant recipients is lower than the general population, however, vaccine effectiveness improved following a third dose.

10.
Transpl Infect Dis ; 2022 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-35579437

RESUMO

BACKGROUND: The COVID-19 pandemic has caused significant morbidity and mortality in solid organ transplant (SOT) recipients. However, it remains unclear whether the risk factor for SOT patients is the immunosuppression inherent to transplantation versus patient comorbidities. METHODS: We reviewed outcomes in a cohort of solid organ transplant (SOT) (n = 129) and non-solid organ (NSOT) transplant patients (n = 708) admitted to the University of California, Los Angeles (UCLA) for COVID-19 infection. Data analyses utilized multivariate logistic regression to evaluate the impact of patient demographics, comorbidities, and transplant status on outcomes. SOT patients were analyzed by kidney SOT (KSOT) versus non-kidney SOT (NKSOT) groups. RESULTS: SOT and NSOT patients with COVID-19 infection differed in terms of patient age, ethnicity, and comorbidities. NKSOT patients were the most likely to experience death, with a mortality rate of 16.2% compared with 1.8% for KSOT and 8.3% for NSOT patients (p = 0.013). Multivariable analysis of hospitalized patients revealed patient age (OR 2.79, p = 0.001) and neurologic condition (OR 2.66, p<0.001) were significantly associated with mortality. Analysis of ICU patients revealed a 2.98-fold increased odds of death in NKSOT compared with NSOT patients (p = 0.013). CONCLUSIONS: This study demonstrates the importance of transplant status in predicting adverse clinical outcomes in patients hospitalized or admitted to the ICU with COVID-19, especially for NKSOT patients. Transplant status and comorbidities including age could be used to risk stratify patients with COVID-19. This data suggests that immunosuppression contributes to COVID-19 disease severity and mortality and may have implications for managing immunosuppression, especially for critically ill patients admitted to the ICU. This article is protected by copyright. All rights reserved.

11.
Transpl Infect Dis ; 2022 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-35579913

RESUMO

INTRODUCTION: The debate on the opportunity to use organs from donors testing positive for SARS-CoV-2 in recipients with naïve, resolved or active COVID-19 is ongoing. We aim to present the ethical analyses underlying the decision to perform liver transplantation (LT) in selected patients with resolved or active COVID-19 in Italy. METHODS: We used Jonsen, Siegler and Winslade's Four-Boxes casuistic method, addressing the four topics considered as constitutive of the essential structure of single clinical cases for their ethical analysis (Medical Indications, Patient Preferences, Quality of Life and Contextual Features) to enable decision-making on a case-by-case basis. Based on these topics, we elucidate the meaning and balance among the principles of biomedical ethics. RESULTS: Clinical ethics judgment based on the relation between the risk of acquiring SARS-CoV-2 along with its potentially negative effects and the expected benefits of transplant lead to consider LT as clinically appropriate. Shared decision-making allows the integration of clinical options with the patient's subjective preferences and considerations, enabling a valid informed consent specifically tailored to the patients' individual circumstances. The inclusion of carefully selected SARS-CoV-2 positive donors represents an opportunity to offer lifesaving LT to patients who might otherwise have limited opportunities to receive one. COVID-19 positive donor livers are fairly allocated among equals, and respect for fundamental rights of the individual and the broader community in a context of healthcare rationing is guaranteed. CONCLUSION: The ethical analysis of the decision to perform LT in selected patients shows that the decision is ethically justifiable. This article is protected by copyright. All rights reserved.

12.
Indian J Ophthalmol ; 70(5): 1817-1818, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35502082

RESUMO

A 28-year-old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID-19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit-lamp examination showed donor stromal edema with Descemet's membrane folds and Khodadoust line (KP's on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle-corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination.


Assuntos
COVID-19 , Doenças da Córnea , Transplante de Córnea , Adulto , Vacinas contra COVID-19/efeitos adversos , Doenças da Córnea/cirurgia , Transplante de Córnea/efeitos adversos , Endotélio , Feminino , Rejeição de Enxerto/diagnóstico , Humanos , Imunização , Complicações Pós-Operatórias , Esteroides , Vacinação , Acuidade Visual
15.
BMC Nephrol ; 23(1): 176, 2022 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-35524223

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produced a pandemic since March 2020 by affecting more than 243 million people with more than 5 million deaths globally. SARS-CoV-2 infection is produced by binding to angiotensin-converting enzyme, which among other sites is highly expressed in the endothelial cells of the blood vessels, pericytes and the heart, as well as in renal podocytes and proximal tubular epithelial cells. SARS-CoV-2 and cardiovascular disease (CVD) are interconnected by risk factors association with an increased incidence of the disease and by determining de novo cardiac complications. At the same time, COVID-19 disease can lead to acute kidney injury directly, or due to sepsis, multi-organ failure and shock. Therefore, the pre-existence of both CVD and chronic kidney disease (CKD) is linked with a higher risk of severe disease and worse prognosis. METHODS: The main aim of this study is to assess the CV risk in a CKD (stage 3 to 5), dialysis and kidney transplanted population, following SARS-CoV-2 infection, with focus on the endothelial dysfunction as compared to a control group of matched patients. By using clinical evaluation, flow-mediated dilatation, carotid-femoral pulse wave velocity, intima-media thickness, echocardiographic parameters, lung ultrasound, bioimpedance spectroscopy and a series of novel biomarkers, the investigators will determine the long-term impact of this disease on CV and renal outcomes. DISCUSSION: This study will address the challenges and implications in long-term CV sequeale of COVID-19 and focus on a better understanding of the underlying mechanisms and possible therapeutic options. TRIAL REGISTRATION: Patient enrolment in the trial started in January 2021 and is expected to finish at the end of 2022. The study can be found on ClinicalTrials.gov database with NCT05125913 identifier. Registered on 18 November 2021 - Retrospectively registered.


Assuntos
COVID-19 , Doenças Cardiovasculares , Insuficiência Renal Crônica , COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Células Endoteliais , Feminino , Humanos , Rim , Masculino , Análise de Onda de Pulso , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/epidemiologia , Medição de Risco , SARS-CoV-2
16.
Pediatr Nephrol ; 2022 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-35538239

RESUMO

BACKGROUND: We report follow-up data from an ongoing prospective cohort study of COVID-19 in pediatric kidney transplantation through the Improving Renal Outcomes Collaborative (IROC). METHODS: Patient-level data from the IROC registry were combined with testing, indication, and outcomes data collected to describe the epidemiology of COVID testing, treatment, and clinical outcomes; determine the incidence of a positive COVID-19 test; describe rates of COVID-19 testing; and assess for clinical predictors of a positive COVID-19 test. RESULTS: From September 2020 to February 2021, 21 centers that care for 2690 patients submitted data from 648 COVID-19 tests on 465 patients. Most patients required supportive care only and were treated as outpatients, 16% experienced inpatient care, and 5% experienced intensive care. Allograft complications were rare, with acute kidney injury most common (7%). There was 1 case of respiratory failure and 1 death attributed to COVID-19. Twelve centers that care for 1730 patients submitted complete testing data on 351 patients. The incidence of COVID-19 among patients at these centers was 4%, whereas the incidence among tested patients was 19%. Risk factors to predict a positive COVID-19 test included age > 12 years, symptoms consistent with COVID-19, and close contact with a confirmed case of COVID-19. CONCLUSIONS: Despite the increase in testing and positive tests over this study period, the incidence of allograft loss or death related to COVID-19 remained extremely low, with allograft loss or death each occurring in < 1% of COVID-19-positive patients and in less than < 0.1% of all transplant patients within the IROC cohort. A higher resolution version of the Graphical abstract is available as Supplementary information.

17.
Kidney Med ; : 100470, 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35493029

RESUMO

Rationale & Objective: Neutralizing monoclonal antibody treatments have shown promising preliminary results in kidney transplant recipients infected with SARS-CoV-2. However, their efficacy in kidney transplant recipients infected with Omicron variant has not been reported yet. Study Design: Single-center retrospective study. Setting & Participants: We included all consecutive kidney transplant recipients treated with monoclonal antibodies for SARS-CoV-2 infection (positive polymerase chain reaction on nasopharyngeal swab) between June 10th 2021 and January 14th 2022. Forty-seven kidney transplant recipients were included. All patients had symptoms evolving for ≤ 7 days and no oxygen therapy need at monoclonal antibody infusion. Results: Symptoms at diagnosis were mainly cough (n=25 [53%]) and fever (n=15 [32%]). Eighty-three percent of the cohort (n=39) had been vaccinated with at least 2 doses before infection, of whom 77% (n=30) had demonstrated a vaccine-induced humoral response. They were treated with either casirivimab-imdevimab (n= 16 [34%]) or sotrovimab (n= 31 [66%]) a median of 2 (ranges 0-6) days after the onset of symptoms. Except for one mild allergic reaction during casirivimab-imdevimab infusion, no side effects were reported. Median viral loads at admission (day 0) and 7 days after mAb infusion were 2,110,027 (ranges 1000-153,798,962) copies/mL and 1,000 (ranges 0-10,000,000) copies/mL, respectively. Genotypes were available for 22 kidney transplant recipients (47%). Omicron, Delta, and Gamma variants were identified in 13 (59%), 8 (36%), 1 (5%) patients, respectively. In kidney transplant recipients infected with Omicron variant, the median viral loads at day 0 and day 7 were 752,789 (ranges 4000-12,859,300) copies/mL and 1,353 (ranges 0-1,211,163) copies/mL, respectively. Two kidney transplant recipients required hospitalization immediately after sotrovimab perfusion for oxygen therapy that was weaned in 3 days allowing patients' discharge. None were admitted to the intensive care unit or died. Limitations: Small sample-size, no control group. Conclusions: Neutralizing monoclonal antibody therapy is associated with positive outcomes in kidney transplant recipients with mild COVID-19, including those infected with the Omicron variant.

18.
Washington, D.C.; OPS; 2022-05-09. (OPS/IMS/HSS/COVID-19/22-0011).
Não convencional em Espanhol | PAHO-IRIS | ID: phr-55971

RESUMO

La pandemia de COVID-19 ha tenido unos efectos sin precedentes en la población, las economías y los servicios de salud de todo el mundo. Pese a las medidas adoptadas para mitigar su impacto, las consecuencias para los sistemas de salud se han hecho evidentes; por ejemplo, en América Latina y el Caribe, donde la actividad de donación y trasplante se ha reducido de manera considerable y, en algunos países, se ha interrumpido por completo. Las presentes recomendaciones de la Organización Panamericana de la Salud tratan de promover el mantenimiento de los servicios de donación y trasplante aun en el curso de la pandemia de COVID-19. Además, plantean sugerencias que puedan tenerse en cuenta en otras situaciones de emergencia de salud o pandemias en las que se requieran medidas de gestión y prevención del riesgo de infecciones. Esta publicación está dirigida a ministerios de salud, organizaciones, organismos o programas nacionales de donación y trasplantes, así como a responsables de la toma de decisiones en este ámbito, profesionales de la salud y otros interesados en la donación y trasplante. Cada país puede adaptar estas recomendaciones a su contexto y ajustarlas periódicamente de acuerdo con la mejor evidencia científica disponible y la experiencia adquirida desde el inicio de la pandemia.


Assuntos
COVID-19 , Serviços de Saúde , Transplante de Órgãos , Transplante de Tecidos , Doações , Telemedicina , Assistência Domiciliar , Assistência de Saúde Universal , América
19.
J Clin Med ; 11(9)2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35566691

RESUMO

Mortality from COVID-19 among kidney transplant recipients (KTR) is high, and their response to three vaccinations against SARS-CoV-2 is strongly impaired. We retrospectively analyzed the serological response of up to five doses of the SARS-CoV-2 vaccine in KTR from 27 December 2020 until 31 December 2021. Particularly, the influence of the different dose adjustment regimens for mycophenolic acid (MPA) on serological response to fourth vaccination was analyzed. In total, 4277 vaccinations against SARS-CoV-2 in 1478 patients were analyzed. Serological response was 19.5% after 1203 basic immunizations, and increased to 29.4%, 55.6%, and 57.5% in response to 603 third, 250 fourth, and 40 fifth vaccinations, resulting in a cumulative response rate of 88.7%. In patients with calcineurin inhibitor and MPA maintenance immunosuppression, pausing MPA and adding 5 mg prednisolone equivalent before the fourth vaccination increased the serological response rate to 75% in comparison to the no dose adjustment (52%) or dose reduction (46%). Belatacept-treated patients had a response rate of 8.7% (4/46) after three vaccinations and 12.5% (3/25) after four vaccinations. Except for belatacept-treated patients, repeated SARS-CoV-2 vaccination of up to five times effectively induces serological response in kidney transplant recipients. It can be enhanced by pausing MPA at the time of vaccination.

20.
Vaccine ; 40(24): 3313-3319, 2022 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-35504784

RESUMO

INTRODUCTION: The remarkable efficacy and effectiveness of COVID-19 vaccines have been described in healthy individuals, but kidney transplant recipients have been excluded from these studies. Therefore, real-world evidence of these vaccines can guide clinicians in predicting complications in kidney transplant recipients and how many doses of vaccines are protective. In this study, we aimed to investigate the impact of the COVID-19 vaccines on kidney transplant recipients with SARS-CoV-2 infection. MATERIAL AND METHOD: This matched case-control study included vaccinated kidney transplant recipients with COVID-19 from two centers between 1 May and 1 October 2021. All patients in the vaccinated group received a minimum of two doses of the vaccine and were diagnosed with COVID-19 at least one month after the last dose. Each vaccinated patient was matched with an unvaccinated kidney transplant recipient diagnosed with COVID. The endpoints were all-cause mortality, hospitalization, intensive care unit admission, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. RESULTS: The median age of vaccinated seventy-two participants was 45 years, and 41 of the participants were men in the vaccinated group. Four patients in the vaccinated group and nine patients in the control group died during follow-up (p = 0.247). Seventeen patients in the vaccinated group, thirty-four participants in the control group were hospitalized (p = 0.004); five vaccinated patients and ten unvaccinated patients were followed-up in the ICU during follow-up (p = 0.168). Thirteen of the vaccinated and twelve unvaccinated patients developed acute kidney injury (p = 0.16). The occurrence of cytokine storm (n = 4 vs. n = 11; p = 0.061) and acute respiratory distress syndrome (n = 5 vs. n = 10; p = 0.168) was higher in the patient group compared to the control group. CONCLUSION: COVID-19 remains a fatal disease despite advancing treatment modalities and preventive strategies. COVID-19 vaccines can't prevent death in all kidney transplant recipients, but they decrease hospitalization rate and duration in most patients.

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