Outpatient management of kidney transplant recipients with suspected COVID-19-Single-center experience during the New York City surge
Outpatient management of kidney transplant recipients with suspected COVID-19-Single-center experience during the New York City surge
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DOI：
10.1111/tid.13383
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发表时间：
2020-07-06
影响因子：
2.6
通讯作者：
Ali, Nicole M.
中科院分区：
文献类型：
--
作者：
Mehta, Sapna A.;Leonard, Jeanette;Ali, Nicole M.
描述2019冠状病毒病（COVID-19）在移植受者中临床进展的数据有限。在纽约市，在COVID-19病例激增期间，在医疗资源紧张、门诊检测有限和医院暴露风险增加的情况下，需要采用系统性方法来监测和分诊免疫功能低下的移植患者。2019冠状病毒病爆发初期的公共卫生指南建议对症状轻微的患者进行门诊监测，但没有对移植受者等特殊人群提出具体建议。我们开发并实施了一种系统性监测算法，用于我们移植中心的肾移植受者，他们报告了提示COVID-19的轻度症状。我们描述了通过该算法监测的前44例患者的结果。共有44名被认为有COVID-19疾病症状的肾移植受者接受了至少14天的随访。大多数轻度症状患者（34/44）出现疾病临床进展，并被转诊至急诊科，所有患者均检测为PCR阳性并需要住院治疗。这些患者中有一半以上出现缺氧，需要补充氧气，39%在48小时内插管，53%发生急性肾损伤，但不需要透析。有6人死亡。在疫情激增期间，即使症状轻微的肾移植患者也很有可能患上COVID-19疾病，大多数人会恶化，需要住院接受支持性措施。早期门诊检测和住院治疗可能会改善移植受者的COVID-19结果。
Data describing the clinical progression of coronavirus disease 2019 (COVID-19) in transplant recipients are limited. In New York City during the surge in COVID-19 cases, a systematic approach to monitoring and triaging immunocompromised transplant patients was required in the context of strained healthcare resources, limited outpatient testing, and heightened hospital exposure risks. Public health guidance at the onset of the COVID-19 outbreak recommended outpatient monitoring of mildly symptomatic patients without specific recommendations for special populations such as transplant recipients. We developed and implemented a systematic monitoring algorithm for kidney transplant recipients at our transplant center who reported mild symptoms suggestive of COVID-19. We describe the outcomes of the first 44 patients monitored through this algorithm. A total of 44 kidney transplant recipients thought to be symptomatic for COVID-19 disease were followed for a minimum of 14 days. The majority of mildly symptomatic patients (34/44) had clinical progression of disease and were referred to the emergency department where they all tested PCR positive and required hospitalization. More than half of these patients presented with hypoxia requiring supplemental oxygen, 39% were intubated within 48 hours, and 53% developed acute kidney injury but did not require dialysis. There were 6 deaths. During surge outbreaks, kidney transplant patients with even mild symptoms have a high likelihood of COVID-19 disease and most will worsen requiring hospitalization for supportive measures. Earlier outpatient testing and hospitalization may improve COVID-19 outcomes among transplant recipients.