First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study
Main result
- 21 patients were included in the study (sample characteristics: median time to transplantation = 47 months, IQR 23-97; 33% women; mean age = 56 years, IQR 49-65; presence of co-morbidities 20/21 patients).
- The most common symptoms were fever(76%), dry cough(57%), nausea(33%), diarrhea(33%) and dyspnea(30%), with a mean distance of 3 days from diagnosis to onset of symptoms, IQR 2-6J.
- All 21 patients underwent hematochemical tests: mean WBC count 4.8 G/L (IQR 3.6-7.8), mean lymphocyte count 0.63 G/L (IQR 0.45-0.97, out of 20 patients), mean PCR 33mg/L (IQR 9-95), mean D-dimer 0.39 μg/ml (IQR 0.28-0.66, out of 9 patients).
- Admission radiographs: Chest radiographs for 14 patients, 6(43%) with interstitial infiltrates and 8(57%) with normal images. CT-scan for 5 patients, all 5 showed frosted glass lesions. 2(10%) patients without radiological examination.
- 5 patients required intensive care and 4 required mechanical ventilation. These patients were older and had fewer co-morbidities than patients who did not require intensive care.
- 7 patients received COVID-19 treatments: 2 hydroxychloroquine, 1 hydroxychloroquine+azithromycin, 1 lopinavir/ritonavir. Immunosuppressive therapy was modified in 14 patients (66.7%).
- After an average of 33 days of follow-up, 16 patients were discharged, 3 patients were still in hospital (2 in intensive care) and 2 patients died.
Takeaways
This study shows that the clinical course of COVID-19 transplant patients is similar to that of the general population.
In particular, it is found that the incidence rate of infection is similar between transplanted patients (21 per 5000 patients) and the general population (284 per 100,000 inhabitants as of April 6, 2020).
The clinical presentation and mortality are similar to those of the general population, but the small number of patients included in the study and the lower average age than the general population (56 years vs 70 years) must be taken into account, as this may partly explain the good results of the patients.
The sample tested had lower inflammatory parameter values than the inpatient population (PCR 33mg/l vs 48 mg/l and D-dimer 0.39 μg/ml vs 0-96 μg/ml).
These results should be evaluated in larger cohort studies with appropriate controls.
Strength of evidence Weak
IF : LOW
1) Multi-centre observational cohort study
2) Small sample (n=21)
3) Short follow-up (average= 33 days)
4) Possible selection bias: only symptomatic patients were screened by RT-PCR
Objectives
Method
Multicentric observational cohort study based on the Swiss Transplant Cohort Study (STCS), a cohort study including more than 90% of the patients who have undergone organ transplantation in Switzerland since 2008.
All STCS patients with a positive RT-PCR test for SARS-CoV-2 between March 9, 2020 and April 6, 2020 were included in the study.
A total of 21 transplant patients were included (10 kidneys, 5 livers, 1 lung, 1 heart and 3 transplants combined).
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