09 Jul Safe Management of Kidney Transplant Patients During COVID-19 Pandemic

MedicalResearch.com Interview with:

Dr. Syed Ali Husain

Syed Ali Husain, MD, MPH
Assistant Professor of Medicine
Division of Nephrology, Department of Medicine
Columbia University College of Physicians and Surgeons and
New York Presbyterian Hospital
The Columbia University Renal Epidemiology Group
New York, New York 

MedicalResearch.com: What is the background for this study?

Response: One group of patients thought to be at a high risk of severe COVID-19 manifestations is kidney transplant recipients, since they take medications that suppress their immune system and they often have other medical problems that have been associated with severe infection. We wanted to understand whether it is safe to manage kidney transplant recipients who develop COVID-19 as outpatients, without admitting them to the hospital.

MedicalResearch.com: What are the main findings?

Response: We found that by using a comprehensive outpatient monitoring protocol, we were able to safely manage the majority of our patients at home and identify clinical deterioration that warranted inpatient admission. Among the 41 patients included in our study with known or highly suspected COVID-19, only one third required hospital admission and none died at home.

Importantly, although the average time between symptom onset and admission was 8 days (similar to the general population), this timing was variable, and one patient was not admitted until 16 days after symptoms started. This indicates that the close outpatient monitoring needs to continue until patients have recovered. 

MedicalResearch.com: What should readers take away from your report?

Response: There is understandably a lot of fear among patients with kidney transplants about developing COVID-19 due to early reports of patients doing very poorly at home. While the infection is certainly serious for this vulnerable group in particular, in the majority of cases patients will get better without needing hospital admission. However, safe management requires close monitoring, especially for the development of shortness of breath, which was the only predictor of needing hospital admission.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Since there was limited testing capability when our study was performed, we still do not know how representative our cohort is. Further research using broad testing of both symptomatic and asymptomatic patients can help us better understand the clinical course of transplant recipients with COVID-19. 

Any disclosures?  We do not have any conflicts of interest to disclose. 

Citation:

Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019

Ali Husain, Geoffrey Dube, Heather Morris, Hilda Fernandez, Jae-Hyung Chang, Kathryn Paget, Sharlinee Sritharan, Shefali Patel, Olga Pawliczak, Mia Boehler, Demetra Tsapepas, R. John Crew, David J. Cohen and Sumit Mohan

CJASN May 2020, CJN.05170420; DOI: https://doi.org/10.2215/CJN.05170420

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Last Updated on July 9, 2020 by Marie Benz MD FAAD