key: cord-0884744-8siwgand
authors: Travi, Giovanna; Rossotti, Roberto; Merli, Marco; Sacco, Alice; Perricone, Giovanni; Lauterio, Andrea; Colombo, Valeriana G.; De Carlis, Luciano; Frigerio, Maria; Minetti, Enrico; Belli, Luca S.; Puoti, Massimo
title: Clinical outcome in solid organ transplant recipients with COVID‐19: A single‐center experience
date: 2020-06-08
journal: Am J Transplant
DOI: 10.1111/ajt.16069
sha: 402b4704a425c8687867a02a0b50f679c878e88d
doc_id: 884744
cord_uid: 8siwgand

We read with great interest the report by Fernandéz-Ruiz and colleagues on the outcome of 18 transplant recipients1 with COVID-19, showing a higher case fatality rate than that reported in the general population. Unlike them, we did not observe higher mortality in transplant setting compared to our overall mortality. We collected data of 13 consecutive solid organ transplant recipients admitted to our Center for COVID-19 between February 21st and April 26th, 2020, with a median follow up of 36 days (IQR 25-41). Our patients were younger (median age 59 versus 71 years) and with a shorter median interval from transplantation (5.3 versus 9.3 years) compared to the Spanish case series. The most common comorbidities were hypertension (54%) and diabetes (31%).

To the Editor:

We read with great interest the report by Fernandéz-Ruiz et al 1 on the outcome of 18 transplant recipients with COVID-19 showing a higher case-fatality rate than that reported in the general population. Unlike these authors, we did not observe a higher mortality in the transplant setting compared with our overall mortality. We case-fatality rate in transplant recipients was similar to that observed in the general population (20% vs 17%, χ 2 test 0.059, P = .807).

In our experience, CNI tapering or withdrawal did not halt deterioration of respiratory failure, suggesting that its maintenance may partially prevent immune activation and the cytokine storm believed to be the driver of the most serious clinical pictures. [2] [3] [4] Interestingly, 2 patients with a recent liver transplant (<2 months before the infection), both treated with 2 doses of basiliximab and high-dose methylprednisolone as induction therapy, did not develop any significant symptom or radiological abnormalities. In conclusion, we did not see a higher mortality in solid organ transplant recipients with COVID-19 and comorbidities appear to play a significant role in the outcome of COVID-19 in this subpopulation, as recently suggested by others. 5 Finally, a better understanding of the pathophysiology of the disease may improve our tailoring of immunomodulation in this specific setting.

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. 

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