key: cord-0938195-5fut7gu2
authors: Poulos, Constantine M.; Kutzler, Heather J.; Cheema, Faiqa; O'Sullivan, David; Morgan, Glyn; Rochon, Caroline; Sheiner, Patricia; Serrano, Oscar K.
title: Considerations in the Assessment of the Solid Organ Transplant Recipient in the COVID-19 Era: The COVID-19 Red Herring Phenomenon
date: 2021-11-30
journal: Journal of the American College of Surgeons
DOI: 10.1016/j.jamcollsurg.2021.07.552
sha: 210eea8e351e876cb874308cb8cb113034bfab5d
doc_id: 938195
cord_uid: 5fut7gu2

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The solid organ transplant (SOT) population is uniquely vulnerable to upper respiratory infections (URI), given their immunosuppressed state. SOT recipients who present with a fever and URI symptoms present a clinical challenge in the COVID-19 era.

We evaluated data from a 7-hospital healthcare system of all SOT recipients with clinical suspicion for COVID-19 infection from March 30 to May 7, 2020 in the early phase of the COVID-19 pandemic. We assessed relevant demographic, clinical, and laboratory data during their hospital course and on followup. We compared characteristics between confirmed COVID-19 SOT cases (COVID19+) and COVID-19 negative SOT patients (COVID19-) who initially presented as a person under investigation (PUI).

: During the study time period, 69 SOT PUI patients were included in the analysis; 53 COVID19-and 16 COVID19+. The overall cohort included 43 kidney, 10 liver, 13 heart, and 3 combined transplants. COVID19+ patients did not differ from COVID19-patients in terms of their baseline demographic characteristics, comorbid conditions, or blood work. Clinically, COVID19+ recipients endorsed ageusia and anosmia at levels that approached (due to small sample size) a significantly higher prevalence (p ¼ 0.05 [1]). Mortality was significantly higher (45.5%) for COVID19+ SOT recipients (p < 0.05). In the COVID19-cohort, respiratory infections (22.6%) were the primary source of symptoms.

CONCLUSION: COVID19+ SOT recipients demonstrate ageusia and anosmia with higher frequency than COVID19-recipients. COVID-19 remains a highly lethal disease in the SOT recipient, underscoring the importance of early identification and treatment. and nondirected donation (NDD) increase organ availability. Potential living donors (PLDs) who initiate donor evaluation with an intended recipient but are incompatible might be amenable to KPD or NDD. This expanded cohort investigates interest in KPD and NDD among these PLDs.

We retrospectively reviewed all PLDs at our center between 1/2017 and 10/2020. Nondirected donors were excluded. PLD interest in KPD or NDD if found to be incompatible with their intended recipient was queried at intake. Multivariable logistic regression was used to quantify the association between PLD characteristics and interest.

RESULTS: Among 1,115 PLDs, 67.5% expressed interest in KPD (n ¼ 753), and 33.5% in NDD (n ¼ 373 CONCLUSION: A majority of PLDs expressed interest in KPD and more than one-third in NDD. Directed PLDs have the potential to increase the organ supply even if they are incompatible with their intended recipient.

Figure 1. Multivariable Logistic Regression for Interest in A) Kidney Paired Donation (KPD) and B) Non-Directed Donation (NDD)

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