COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave?
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Coll Elisabeth, Fernández-Ruiz Mario, Padilla María, Moreso Francesc, Hernández-Vicente Ana, Yañez Iñigo, Molina María, Vázquez-Sánchez Teresa, Crespo Marta, Facundo Carme, Rodríguez-Ferrero María Luisa, Ruiz Fuentes María Carmen, Loinaz Carmelo, Bernal Gabriel, Melilli Edoardo, Bravo Carlos, Diekmann Fritz, Lladó Laura, García-Álvarez Teresa M, Salcedo Magdalena, Beneyto Isabel, Castells Lluis, Alonso Rodrigo, Rodríguez-Benot Alberto, Díaz-Corte Carmen, Graus Javier, Ortiz-Bautista Carlos, García-Cosío María Dolores, Hinojal Rosa, Peña Lucía, Domínguez-Gil Beatriz, Spanish Group for the Study of COVID-19 in Transplant Recipients.
Аннотация
METHODS: In this multicenter, nationwide, prospective study, we compared demographics and clinical features, therapeutic management, and outcomes in SOT recipients diagnosed with COVID-19 in Spain before (first wave) or after (second wave) 13 July 2020.
RESULTS: Of 1634 SOT recipients, 690 (42.2%) and 944 (57.8%) were diagnosed during the first and second periods, respectively. Compared with the first wave, recipients in the second were younger (median: 63 y [interquartile range, IQR: 53-71] versus 59 y [IQR: 49-68]; P < 0.001) and less likely to receive anti-severe acute respiratory syndrome coronavirus 2 drugs (81.8% versus 8.1%; P < 0.001), with no differences in immunomodulatory therapies (46.8% versus 47.0%; P = 0.931). Adjustment of immunosuppression was less common during the second period (76.4% versus 53.6%; P < 0.001). Hospital admission (86.7% versus 58.1%; P < 0.001), occurrence of acute respiratory distress syndrome (34.1% versus 21.0%; P < 0.001), and case-fatality rate (25.8% versus 16.7%; P < 0.001) were lower in the second period. In multivariate analysis, acquiring COVID-19 during the first wave was associated with an increased risk of death (OR: 1.47; 95% confidence interval [CI], 1.12-1.93; P = 0.005), although this impact was lost in the subgroup of patients requiring hospital (OR: 0.97; 95% CI, 0.73-1.29; P = 0.873) or intensive care unit admission (OR: 0.65; 95% CI, 0.35-1.18; P = 0.157).
CONCLUSIONS: We observed meaningful changes in demographics, therapeutic approaches, level of care, and outcomes between the first and second pandemic waves. However, outcomes have not improved in the more severe cases of posttransplant COVID-19.