Advances in Transplant

In a series of 6 recently published papers, the Kidney and Pancreatic Transplant Program and the Department of Nephrology at NewYork-Presbyterian/Columbia University Irving Medical Center are sharing their experience to help other centers around the country who are undergoing a pandemic surge.

Outpatient kidney transplant recipient case series

• In a retrospective case series published in the Clinical Journal of the American Society of Nephrology, researchers at NewYork-Presbyterian/Columbia describe their experience with 41 outpatient kidney transplant recipients with known or suspected COVID-19 between March 13 and April 6, 2020.
• The majority of kidney transplant recipients with COVID-19 did not require hospitalization and received outpatient care via telemedicine.
• Only 1/3 of patients required inpatient care, but the timing of hospitalization varied widely with a median of 8 days and as late as 16 days after symptom onset.
• The authors highlight the need for increased monitoring beginning 1 week after symptom onset to assess for clinical deterioration and late worsening of symptoms requiring hospitalization.
• Hospitalized patients were more likely to have dyspnea than patients who had resolution of symptoms (77% vs 21%), suggesting that close monitoring is warranted for patients with dyspnea.
• More than half of patients (56%) saw symptom resolution at a median of 12 days, with a maximum of 23 days, calling in to question whether duration of symptoms is associated with poor outcomes.
• The experience at NewYork-Presbyterian/Columbia illustrates that during a pandemic surge, a comprehensive outpatient monitoring protocol including telemedicine visits every 6, 24, or 48 hours (depending on symptom severity) can be used to safely monitor outpatient kidney transplant recipients with COVID-19 infection.

Inpatient kidney transplant recipients case series

• In the Journal of the American Society of Nephrology, the Kidney Transplant Program at NewYork-Presbyterian/Columbia presents a case series of 15 kidney transplant recipients with COVID-19 infection who required hospitalization.
• Intubation was required in 27% of patients, more than half of inpatient kidney transplant recipients were discharged, and 2 patients died at the time of study publication.

Kidney biopsy case series

• In the Journal of the American Society of Nephrology, researchers at NewYork-Presbyterian/Columbia analyzed biopsy samples in 17 kidney transplant recipients with COVID-19 infection for evidence of acute kidney injury between March and June of 2020.
• A diverse kidney pathology was found including glomerular and tubular diseases.
• Notably, virus particles were not found in kidney cells, suggesting that viral infection of the kidneys is not the major pathomechanism for COVID-19, but rather kidney injury is related to cytokine-mediated effects.

Pancreas transplant recipient case series

• In Transplant Infectious Disease, the Department of Nephrology at NewYork-Presbyterian/Columbia reports the first 4 published cases of COVID-19 infection in pancreas transplant recipients.
• Notably, a transient reduction in immunosuppression was associated with mild disease in 3 out of 4 patients and there was no evidence of acute allograft rejection. Mycophenolate was restarted in 2 patients 5-7 days after resolution of fevers.
• The authors emphasize that long-term data is needed to understand how reducing immunosuppression at disease onset will affect cytokine storm syndrome and when immunosuppression in recovered patients can be safely introduced.
• The authors noted that although virus particles have been found in kidney ACE2 receptors of autopsies from non-transplant patients with SARS-CoV-2, no changes in glycemic control or pancreas enzymes were observed in this case series, suggesting stable allograft function in the short-term.

Solid organ transplant recipient retrospective cohort study

• In the American Journal of Transplantation, researchers at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medicine collaborated to share their experience across all solid organ transplants—kidney, lung, heart, and dual organ transplants—during a 3 week period during the height of the outbreak in New York City.
• The cohort included 90 transplant recipients (46 or 51% of which were kidney recipients) who tested positive for COVID-19 in an inpatient or outpatient setting from March 13 to April 3, 2020.
• Out of 90 transplant recipients, 68 were hospitalized and 23 required ICU admission (26% overall, 34% of inpatients), suggesting that that transplant recipients may be at high risk of severe disease and poor outcomes.
• Patients with severe disease were older, more likely to have hypertension, and had dyspnea. Sixteen transplant recipients from the cohort died from COVID-19 complications and the mortality rate was 24% of inpatients and 52% of ICU patients.

Nephrology team response to COVID-19

• In the Journal of the American Society of Nephrology, the Department of Nephrology at NewYork-Presbyterian/Columbia shares lessons learned and how the team reorganized services to respond to a surge of patients with underlying kidney diseases who were infected with COVID-19.
• The report describes the team’s data-driven response and highlights specific ways clinical services were reorganized to provide care for a surge of patients while ensuring provider safety.

Why NewYork-Presbyterian?

We are committed to sharing the lessons we’ve learned from the pandemic with other centers in order to provide optimal care for patients and ensure safety for providers. In light of SARS-COV2, the Kidney and Pancreas Transplant Program at NewYork-Presbyterian is taking special precautions. Currently, we are performing transplant procedures and providing non-emergency telemedicine visits. To refer a patient, please call 646-859-3722.

More Information

For more information about our Kidney Transplant, please visit the kidney transplant section of our website.