Changing trends in mortality among solid organ transplant recipients hospitalized for COVID‐19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020-June 19, 2020) and late 2020 (June 20, 2020-December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46-0.98, p = .016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study

Post-transplant Malignancies: Current Perspective on Risk Factors, Prevention, and Management

Post-transplant malignancies arise from a complex interplay of factors, with immunosuppression playing a pivotal role. Chronic immunosuppressive treatment compromises the recipient’s immune system, rendering it less eficient at recognizing and eliminating malignant cells. Additionally, viral infections, especially Epstein–Barr virus and Human papillomavirus, are major contributors to malignancy development. Lifestyle modifcations, including smoking cessation and sun protection, are recommended for reducing certain cancer risks. Regular screening for malignancies may provide the early diagnosis as in the general population. Afer the diagnosis of cancer, tailoring immunosuppressive regimens to maintain graf function is crucial. Treatment options, such as chemotherapies, targeted therapies, and immunotherapies, should be selected with consideration of the patient’s overall health and the potential impact on the transplanted organ. A multidisciplinary approach is required in order to provide optimal treatment to our kidney transplant recipients. With this review article, we aim to discuss pathophysiological mechanisms, review guidelines, and provide information on the incidence and management options for various cancers

Post-transplant malignancies : current perspective on risk factors, prevention, and management

Abstract: Post-transplant malignancies arise from a complex interplay of factors, with immunosuppression playing a pivotal role. Chronic immunosuppressive treatment compromises the recipient's immune system, rendering it less efficient at recognizing and eliminating malignant cells. Additionally, viral infections, especially Epstein-Barr virus and Human papillomavirus, are major contributors to malignancy development. Lifestyle modifications, including smoking cessation and sun protection, are recommended for reducing certain cancer risks. Regular screening for malignancies may provide the early diagnosis as in the general population. After the diagnosis of cancer, tailoring immunosuppressive regimens to maintain graft function is crucial. Treatment options, such as chemotherapies, targeted therapies, and immunotherapies, should be selected with consideration of the patient's overall health and the potential impact on the transplanted organ. A multidisciplinary approach is required in order to provide optimal treatment to our kidney transplant recipients. With this review article, we aim to discuss pathophysiological mechanisms, review guidelines, and provide information on the incidence and management options for various cancers

The association between perceived stress with sleep quality, insomnia, anxiety and depression in kidney transplant recipients during Covid-19 pandemic

Background The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic. Material and methods A hundred-six kidney transplant recipients were enrolled. Questionnaire of "Socio-demographics", "Perceived Stress Scale (PSS)", "Pittsburgh Sleep Quality Index (PSQI)", "Insomnia Severity Index (ISI)" and “Hospital Anxiety Depression Scale (HADS)” are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated. Results The mean age of patients was 44.2±13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09±4.17 vs 6.49±4.16, p:0.014) and the patients who have a rejection episode any of time (8.24±5.16 vs 6.37±3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D. Conclusions High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients. </jats:sec