SARS-CoV-2-Infektionen und klinische Konsequenzen bei organtransplantierten Patienten im Rahmen der ersten Ansteckungswelle in Deutschland - eine monozentrische Umfrage und ein Fallbericht

Zusammenfassung

Hintergrund Die SARS-CoV-2-Pandemie hat zu einer globalen Gesundheitskrise mit hohen Mortalitätsraten insbesondere bei Betroffenen in Hochrisikogruppen geführt. Eine stetig wachsende Zahl klinischer Fallberichte zeigt die Folgen von COVID-19 bei Patienten nach solider Organtransplantation (SOT) und deutet auf schwerwiegende klinische Auswirkungen und eine insgesamt hohe Sterblichkeit in dieser Patientengruppe hin. Systematische Daten zu SARS-CoV-2-Infektionen bei SOT-Empfängern in Deutschland fehlten zunächst jedoch weitgehend.

Patienten und Methoden Wir führten deshalb eine Umfrage zum SARS-CoV-2-Infektionsstatus unter insgesamt 387 Patienten nach SOT durch, die in den letzten 5 Jahren an unserem Zentrum transplantiert wurden. Die Umfrage wurde 2 Monate nach dem ersten SARS-CoV-2-Ausbruch in unserer relativ stark betroffenen Region und den damit verbundenen staatlich verordneten Einschränkungen durchgeführt.

Ergebnisse In unserer SOT-Kohorte wurde eine Rate von 0,4% SARS-CoV-2-positiven Patienten ermittelt, was gut mit den lokalen Infektionsraten in der Allgemeinbevölkerung zum damaligen Zeitpunkt übereinstimmt. Allerdings führte die einzige uns in diesem Kollektiv bekannt gewordene SARS-CoV-2-Infektion zu schwerer Morbidität mit verlängerter mechanischer Beatmung, einem Krankenhausaufenthalt > 60 Tage und resultierte letztlich im irreversiblen Verlust der Transplantatfunktion.

Schlussfolgerung Unsere Daten zeigen, dass SOT-Empfänger im Vergleich zur Allgemeinbevölkerung zwar ein vergleichbares Risiko für eine SARS-CoV-2-Infektion haben, diese jedoch mit der Gefahr von schwerwiegenderen Verläufen assoziiert zu sein scheint.

Abstract

Background The SARS-CoV-2 pandemic has caused an unprecedented global health crisis, with exceptionally high mortality rates in high-risk groups of affected patients. It is alarming that a steadily increasing number of clinical reports on outcomes of COVID-19 in solid organ transplant (SOT) recipients suggests a detrimental impact linked to high overall mortality. However, systematic data on SARS-CoV-2 infections in SOT recipients in Germany are still scarce.

Material and Methods We conducted a survey on SARS-CoV-2 infection status among 387 SOT recipients treated at our centre during the past 5 years – located in a severely affected region in Germany. The survey was sent out two months after the first SARS CoV-2 outbreak in our region had resulted in government-imposed lockdown measures.

Results An incidence rate of 0.4% SARS-CoV-2-positive SOT recipients was determined in our cohort, in line with reported local infection rates in the general population at this time. However, the only SARS CoV-2 infection known to us within this group of patients led to severe morbidity – resulting in prolonged mechanical ventilation, hospitalisation > 60 days and finally in irreversible loss of graft function.

Conclusion Our data demonstrate that SOT recipients are at equal risk for SARS-CoV-2 infections when compared to the general population, while SARS-CoV-2 infections in SOT recipients seem to be associated with deleterious clinical consequences.

Schlüsselwörter

Transplantationschirurgie - Infektion - COVID-19 - SARS-CoV-2

Keywords

COVID-19 - SARS-CoV-2 - Infection - Transplantation

Publication History

Received: 21 February 2021

Accepted after revision: 12 July 2021

Article published online:
29 September 2021

• Literatur

• 1 Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; 20: 533-534 DOI: 10.1016/S1473-3099(20)30120-1. (PMID: 32087114)
• 2 Alqahtani JS, Oyelade T, Aldhahir AM. et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One 2020; 15: e0233147 DOI: 10.1371/journal.pone.0233147. (PMID: 32392262)
• 3 Singh AK, Gillies CL, Singh R. et al. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis. Diabetes Obes Metab 2020; 22: 1915-1924 DOI: 10.1111/dom.14124. (PMID: 32573903)
• 4 COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; 396: 27-38 DOI: 10.1016/S0140-6736(20)31182-X.
• 5 Kreidl P, Schmid D, Maritschnik S. et al. Emergence of coronavirus disease 2019 (COVID-19) in Austria. Wien Klin Wochenschr 2020; 132: 645-652 DOI: 10.1007/s00508-020-01723-9. (PMID: 32816114)
• 6 Correa-Martinez CL, Kampmeier S, Kumpers P. et al. A Pandemic in Times of Global Tourism: Superspreading and Exportation of COVID-19 Cases from a Ski Area in Austria. J Clin Microbiol 2020; 58: e00588-20 DOI: 10.1128/JCM.00588-20. (PMID: 32245833)
• 7 Robert Koch-Institut (RKI). Coronavirus SARS-CoV-2 – COVID-19: Fallzahlen in Deutschland und weltweit. 2020 Im Internet (Stand: 07.10.2020): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html
• 8 Fishman JA. Infection in Organ Transplantation. Am J Transplant 2017; 17: 856-879 DOI: 10.1111/ajt.14208. (PMID: 28117944)
• 9 Akalin E, Azzi Y, Bartash R. et al. Covid-19 and Kidney Transplantation. N Engl J Med 2020; 382: 2475-2477 DOI: 10.1056/NEJMc2011117. (PMID: 32329975)
• 10 Cravedi P, Mothi SS, Azzi Y. et al. COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium. Am J Transplant 2020; 20: 3140-3148 DOI: 10.1111/ajt.16185. (PMID: 32649791)
• 11 Webb GJ, Moon AM, Barnes E. et al. Determining risk factors for mortality in liver transplant patients with COVID-19. Lancet Gastroenterol Hepatol 2020; 5: 643-644 DOI: 10.1016/S2468-1253(20)30125-4. (PMID: 32339474)
• 12 Moosavi SA, Mashhadiagha A, Motazedian N. et al. COVID-19 clinical manifestations and treatment strategies among solid-organ recipients: A systematic review of cases. Transpl Infect Dis 2020; 22: e13427 DOI: 10.1111/tid.13427. (PMID: 32779820)
• 13 Karagiannidis C, Mostert C, Hentschker C. et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 2020; 8: 853-862 DOI: 10.1016/S2213-2600(20)30316-7. (PMID: 32735842)
• 14 Akdur A, Karakaya E, Ayvazoglu Soy EH. et al. Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience. Exp Clin Transplant 2020; 18: 564-571 DOI: 10.6002/ect.2020.0388. (PMID: 33143601)
• 15 Donato MF, Invernizzi F, Lampertico P. et al. Health Status of Patients Who Underwent Liver Transplantation During the Coronavirus Outbreak at a Large Center in Milan, Italy. Clin Gastroenterol Hepatol 2020; 18: 2131-2133.e1 DOI: 10.1016/j.cgh.2020.04.041.
• 16 Coll E, Fernandez-Ruiz M, Sanchez-Alvarez JE. et al. COVID-19 in transplant recipients: The Spanish experience. Am J Transplant 2021; 21: 1825-1837 DOI: 10.1111/ajt.16369. (PMID: 33098200)
• 17 Trapani S, Masiero L, Puoti F. et al. Incidence and outcome of SARS-CoV-2 infection on solid organ transplantation recipients: A nationwide population-based study. Am J Transplant 2021; 21: 2509-2521 DOI: 10.1111/ajt.16428. (PMID: 33278850)
• 18 Mamode N, Ahmed Z, Jones G. et al. Mortality Rates in Transplant Recipients and Transplantation Candidates in a High-prevalence COVID-19 Environment. Transplantation 2021; 105: 212-215 DOI: 10.1097/TP.0000000000003533. (PMID: 33196624)
• 19 Fava A, Cucchiari D, Montero N. et al. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant 2020; 20: 3030-3041 DOI: 10.1111/ajt.16246. (PMID: 32777153)
• 20 Sran K, Olsburgh J, Kasimatis T. et al. COVID-19 in Kidney Transplant Patients From a Large UK Transplant Center: Exploring Risk Factors for Disease Severity. Transplant Proc 2021; 53: 1160-1168 DOI: 10.1016/j.transproceed.2020.11.007. (PMID: 33483166)
• 21 Elias M, Pievani D, Randoux C. et al. COVID-19 Infection in Kidney Transplant Recipients: Disease Incidence and Clinical Outcomes. J Am Soc Nephrol 2020; 31: 2413-2423 DOI: 10.1681/ASN.2020050639. (PMID: 32847984)
• 22 Becchetti C, Zambelli MF, Pasulo L. et al. COVID-19 in an international European liver transplant recipient cohort. Gut 2020; 69: 1832-1840 DOI: 10.1136/gutjnl-2020-321923. (PMID: 32571972)
• 23 Bossini N, Alberici F, Delbarba E. et al. Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience. Am J Transplant 2020; 20: 3019-3029 DOI: 10.1111/ajt.16176. (PMID: 32627319)
• 24 Montagud-Marrahi E, Cofan F, Torregrosa JV. et al. Preliminary data on outcomes of SARS-CoV-2 infection in a Spanish single center cohort of kidney recipients. Am J Transplant 2020; 20: 2958-2959 DOI: 10.1111/ajt.15970. (PMID: 32368838)
• 25 Rodriguez-Cubillo B, de la Higuera MAM, Lucena R. et al. Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2?. Am J Transplant 2020; 20: 3173-3181 DOI: 10.1111/ajt.16141. (PMID: 32529737)
• 26 Devresse A, Belkhir L, Vo B. et al. COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Case Series of 22 Cases From Belgium. Kidney Med 2020; 2: 459-466 DOI: 10.1016/j.xkme.2020.06.001. (PMID: 32775986)
• 27 Alberici F, Delbarba E, Manenti C. et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int 2020; 97: 1083-1088 DOI: 10.1016/j.kint.2020.04.002. (PMID: 32354634)
• 28 Marinaki S, Tsiakas S, Korogiannou M. et al. A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts. J Clin Med 2020; 9: 2986 DOI: 10.3390/jcm9092986. (PMID: 32947798)
• 29 Reuken PA, Rauchfuss F, Albers S. et al. Between fear and courage: Attitudes, beliefs, and behavior of liver transplantation recipients and waiting list candidates during the COVID-19 pandemic. Am J Transplant 2020; 20: 3042-3050 DOI: 10.1111/ajt.16118. (PMID: 32515125)
• 30 Flaxman S, Mishra S, Gandy A. et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020; 584: 257-261 DOI: 10.1038/s41586-020-2405-7. (PMID: 32512579)