Covid-19 virus in Intestinal Transplant Patients: Allograft Survival Rate and Associated Therapies - An inclusive UPMC Intestinal Transplantation and Rehabilitation Center Study

Introduction: The COVID-19 outbreak was recognized as a global pandemic March 11th, 2020. Throughout medical centers spanning over the entire world, health care adaptation and change occur at a rapid rate. Intestinal transplant patients were considered at the highest level of infection susceptibility and possible complications. The purpose of this study is to describe a single center experience of COVID-19 infection in intestinal transplant (IT) patient’s, treatments used, and effect of the infection on the patient/graft survival rate. Methods: We performed a chart review of all intestinal transplant recipients with confirmed COVID-19 results between January 2020 through January 2023 and extracted presenting symptoms, documented treatments, hospitalization course and ultimately graft and patient survival. Results: Eleven adult patients had confirmed COVID-19 infections. Visceral allografts include 7 isolated small bowel transplant, 2 full multivisceral transplant and 1 modified multi-visceral transplant. Seven patients were female (64%) with median age of 45.8 yo (ranging 31 to 63 yo). Maintenance immunosuppression consisted of combination of tacrolimus and corticoids in all the cases. Two patients we also on mycophenolate. All COVID-positive IT patients were vaccinated against COVID. Of the patient’s whose last vaccination is known, the average time to infection was 265 days (range: 24-547). One patient had recurrence of his COVID infection after treatment. Eight patients (73%) required hospitalization at the transplant ward unit (n=6) and ICU (n=2). One patient (50%) of ICU admissions required vent support. Three patients did not require hospital admission. Treatment modalities consisted of monoclonal antibodies (Bebtelovimab, 175 mg x1 dose) in four patients and intravenous antivirals (Remdesivir, 200 mg x1 dose, followed by 100 mg/dose x 2 doses every 24 hours) in five patients. Three patients did not receive any treatment. Two patients developed irreversible respiratory failure and one patient developed exfoliative rejection requiring allograft enterectomy. Eight patients are still alive with good allograft function (73%). Conclusion: We demonstrated that COVID-19 infections in IT patients remains a considerable morbidity and mortality, with significant admission rates (73%). Interestingly, most of the infections occurred after 2021 suggesting that there is a correlation to either increased virulence of the COVID-19 virus or relaxation of contact precautions, however, further study is required to sustain this observation. To date this is the largest single center report on treatment and outcome in patients with visceral transplantation and COVID-19 infection.