scholarly journals COVID‐19 in lung transplant recipients: A single center case series from New York City

2020 ◽  
Vol 20 (11) ◽  
pp. 3072-3080 ◽  
Author(s):  
Meghan Aversa ◽  
Luke Benvenuto ◽  
Michaela Anderson ◽  
Lori Shah ◽  
Hilary Robbins ◽  
...  
2020 ◽  
Vol 11 ◽  
Author(s):  
Sara Radmard ◽  
Samantha E. Epstein ◽  
Hannah J. Roeder ◽  
Andrew J. Michalak ◽  
Steven D. Shapiro ◽  
...  

2021 ◽  
Vol 40 (4) ◽  
pp. S314
Author(s):  
L.L. Seijo ◽  
A. Perez ◽  
N. Thakur ◽  
A. Venado ◽  
L.E. Leard ◽  
...  

2021 ◽  
Vol 2 (2) ◽  
pp. 229-245
Author(s):  
René Hage ◽  
Carolin Steinack ◽  
Fiorenza Gautschi ◽  
Susan Pfister ◽  
Ilhan Inci ◽  
...  

We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.


2021 ◽  
Author(s):  
Danielle Seidman ◽  
Brittney S. Zimmerman ◽  
Lauren Margetich ◽  
Serena Tharakan ◽  
Natalie Berger ◽  
...  

Author(s):  
Demetra Tsapepas ◽  
S Ali Husain ◽  
Kristen L King ◽  
Yvonne Burgos ◽  
David J Cohen ◽  
...  

Abstract Purpose Solid organ transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19), but limited vaccine access and vaccine hesitancy can complicate efforts for expanded vaccination. We report patient perspectives and outcomes from a vaccine outreach initiative for a vulnerable population of transplant recipients living in New York City. Methods This was a retrospective review of qualitative perspectives from a COVID-19 vaccine outreach initiative. In the outreach effort, kidney and pancreas transplant recipients under care at the transplant center at NewYork-Presbyterian Hospital were initially contacted electronically with educational material about vaccination followed by telephone outreach to eligible unvaccinated patients. Calls were used to schedule vaccine appointments for patients who agreed, answer questions, and assess attitudes and concerns for patients not yet ready to be vaccinated, with conversational themes recorded. Results Of the 1,078 patients living in the 5 New York City boroughs who had not reported receiving COVID-19 vaccination, 320 eligible patients were contacted by telephone. Of these, 210 patients were scheduled for vaccination at our vaccine site (including 13 who agreed to vaccination after initially declining), while 110 patients were either not ready or not interested in being vaccinated. The total number of patients willing to be vaccinated was 554 when also including those already vaccinated. Unwillingness to be vaccinated was associated with younger age (median age of 47 vs 60 years, P < 0.001), Black race (P = 0.004), and residence in Bronx or Brooklyn counties (P = 0.018) or a zip code with a medium level of poverty (P = 0.044). The most common issues raised by patients who were ambivalent or not interested in vaccination were regarding unknown safety of the vaccines in general, a belief that there was a lack of data about the vaccines in transplant recipients, and a lack of trust in the scientific process underlying vaccine development, with 34% of the patients contacted expressing vaccine hesitancy overall. Conclusion Our qualitative summary identifies determinants of COVID-19 vaccine hesitancy in a diverse transplant patient population, supporting the need for transplant centers to implement tailored interventions to increase vaccine acceptance in this vulnerable population.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 16-16
Author(s):  
Guilherme Sacchi De Camargo Correia ◽  
Sridevi Rajeeve ◽  
Lawrence Cytryn

Factor XI (FXI) deficiency is a rare bleeding disorder. In the general population, prevalence is estimated to be 1:1 million people for the homozygous presentation (PMID: 25100430). Nonetheless, in individuals of Ashkenazi and Iraqi Jewish ancestry, the prevalence of heterozygous cases is approximately 8% (PMID: 7811996). However, these numbers may be underestimates, as some patients are asymptomatic and, so, not accounted for. Pregnant women are a special population, as FXI deficiency may pose an increased risk during pregnancy and delivery. This study describes the experience of a General Hematology Outpatient Service to which pregnant women with FXI deficiency are referred. This case series aims to describe the clinical course of these patients, and any complications and interventions they may have experienced during pregnancy and delivery. This retrospective study identified a group of 49 patients with FXI deficiency who were evaluated by a single practitioner at the Hematology Outpatient Service at Mount Sinai West, in New York City, between October 2016 and February 2020. Patients were found to be FXI deficient on routine genetic screening early in their obstetric care. Their charts were reviewed, including epidemiological data, notes from Hematology and Obstetric Clinics and from the admission for delivery and laboratory results. Four patients were excluded from the final analysis: 3 who were not pregnant, and 1 who did not have FXI deficiency. Patients were seen in by the Hematology Service at least once during their pregnancy. FXI activity was measured at least twice during pregnancy: at the initial visit, and at about gestational week 37. The data were analyzed to obtain the mean and standard deviation for the most relevant clinical parameters. A comparison between FXI activity at the first visit and at last visit near term was made with a paired T-test. The included group of 45 patients presented a mean age at delivery of 34.09 years (range 26-45 years). Genetic data was available for 42 patients, with 2.38% being homozygous. Ethnicities were described for 39 patients, and 71.79% were identified as Ashkenazi Jewish. Among 39 patients who had their FXI gene (gene NM_000128.3) mutations described, the c.901T>C, p.F301L mutation was present in 61.54% of them. The mean FXI activity measured in the first appointment was 60.18%, (range 4-220%), while the mean FXI activity in week 37 of pregnancy was 52.08% (range 13-118%). When comparing the FXI activity on the first appointment and around week 37, no statistically significant difference was found (p=0.17). Four patients received preventive interventions on delivery. One patient was treated with Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) transfusion due to a FXI activity of 21% on week 37, and received general anesthesia. Two patients received transfusion of FFP alone: 1 of them due to an elevated aPTT (57.4s) on delivery date, with no anesthesia on delivery; and the other one as a preventive measure in a patient with a FXI of 45% on week 37, but who was planned for a neuraxial block. A FXI activity of 40% is the cutoff for a neuraxial block by the Anesthesiology Department at our hospital. One patient was treated with TXA due to a borderline FXI activity of 42% and a personal history of bleeding on surgical procedures. She had an opioid patient-controlled analgesia on delivery. For the detailed data regarding mean blood loss on delivery, postpartum blood loss, and complete Hematologic and Obstetric data, see tables 1 and 2, and figures 1 and 2. Figure 3 presents a data comparison between the 2 most common genotypes observed. In our case series, no patient experienced bleeding complications during pregnancy or delivery. Monitoring FXI levels and aPTT throughout pregnancy and before delivery remains as the standard medical care (PMID: 27699729). The difference between FXI levels earlier in pregnancy and near delivery was not statistically significant, as noted in previous studies (PMID: 15199489). Checking FXI activity throughout pregnancy may not be necessary, and one measurement might be enough. Further study might be able to answer this question, as the optimal management of these patients remains a work in progress. Evidence for a reliable threshold FXI activity at which neuraxial anesthesia could be safely performed will be a valuable finding. Continuation of our study will allow for further data regarding the management of FXI deficient pregnant women. Disclosures No relevant conflicts of interest to declare.


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