key: cord-0755735-80xdyhbp
authors: Kamar, Nassim; Esposito, Laure; Hebral, Anne Laure; Guitard, Joelle; Del Bello, Arnaud
title: Specific organization for in‐hospital belatacept infusion to avoid nosocomial transmission during the SARS‐CoV‐2 pandemic
date: 2020-05-24
journal: Am J Transplant
DOI: 10.1111/ajt.16074
sha: 6d6e00a447162b92c8354ed241ce8d15d9078197
doc_id: 755735
cord_uid: 80xdyhbp

The first cases of Severe Acute Respiratory Syndrome coronavirus 2 (SARS‐CoV‐2) occurred in France in early February and in our region (Southwest France) in early March 2020.

To the Editor:

The first cases of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) occurred in France in early February and in our region (Southwest France) in early March 2020.

The stay-at-home order became effective in France on March 17th. Immunocompromised patients were asked to stay confined and outpatient clinic visits were dramatically reduced. As 

This article is protected by copyright. All rights reserved to detect respiratory symptoms, each patient received a mask, gloves were removed and patients were asked to take hand hygiene measures using an alcohol-based hand cleanser. Each patient was admitted to an isolated room. All health workers wore masks.

On May 9th, nucleic acid tests were SARS-CoV-2 positive for 7,398 patients in our region.

We admitted four hundred and sixty patients. Twenty-three transplant patients were hospitalized for confirmed COVID-19. Among belatacept-treated patients, only one case of suspected COVID-19 was identified in a kidney transplant patient during telephone screening. He had a fever and respiratory symptoms. He was admitted to the unit dedicated to patients with suspected COVID-19. An oropharyngeal swab specimen was obtained which detected SARS-Cov-2. Chest CT showed multiple patchy ground-glass opacities. He was hospitalized, belatacept was discontinued and no cytokine storm was noted. He was discharged 1 month later. Recently, Marx et al. reported a rapid recovery in the first case of COVID-19 in a patient on belatacept. This patient presented no cytokine release either. They hypothesized that the mild clinical course of COVID-19 observed in their patient may have been, at least partially, due to a belatacept-related blockade of massive cytokine/chemokine production (2).

Since the stay-at-home order, the 112 remaining patients have received their belatacept infusions monthly (3 times each). No symptom that required SARS-CoV-2 testing was detected.

No nosocomial transmission occurred in our patients treated with belatacept. Therefore, instead of a potentially risky change in immunosuppressive regimen, we suggest organizing a dedicated infection control protocol with stringent barrier precautions for patients requiring regular outpatient infusion during the COVID-19 pandemic.

Outpatient Management of the kidney transplant recipient during the SARS-Cov-2 virus pandemic

First case of COVID-19 in a kidney transplant recipient treated with belatacept

Email: kamar.n@chu-toulouse.fr

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation NK has received lecture fees from Astellas, Novartis, Gilead, Neovii, MSD, Octapharma, Amgen and travel grants from Astellas, CSL Behring, Novartis, and Alexion.The other authors have no conflicts of interest to disclose.

This article is protected by copyright. All rights reserved