Outpatient cases |
Case |
Gender/age (y) |
Race or ethnicity |
Organ/time interval (y) |
BMI |
Major comorbidities |
Indication for testing |
Immunosuppression at testing |
Immunosuppression changes |
Treatment |
1 |
58 |
White |
Kidney/7.8 |
21 |
GN, breast cancer, HLD |
Cough, “cold like symptoms” |
Sirolimus (trough 6.7 ng/mL), prednisone 5 mg |
None |
Supportive care |
2 |
81 |
Other |
Kidney/14.4 |
45 |
HTN, SCC |
Fever, chills, night sweats, rhinorrhea, cough, body aches |
Tacrolimus (trough 5.7 ng/mL), MMF 1000 mg TDD, prednisone 2.5 mg |
None |
Supportive care |
3 |
47 |
White |
Kidney/24.3 |
22 |
HTN, HLD, multiple myloma |
Fever, cough, sore throat, body aches |
Prednisone 5 mg |
None |
Supportive care |
4 |
44 |
Hispanic |
Kidney/0.4 |
35 |
HTN, DM, asthma, sleep apnea |
Fever, SOB, body aches |
Tacrolimus (trough 7.6 ng/mL), MMF 1000 mg TDD |
Reduced MMF to 500 mg TDD |
Azithromycin |
Inpatient cases
|
|
|
|
|
|
|
Case |
Age (y) |
Race or ethnicity |
Organ/time interval (y) |
From SNF/DNR on file |
BMI |
Major comorbidities |
Indication for testing |
IS at testing |
IS changes |
Treatment beyond supportive care |
Complications |
Outcome |
5 |
64 |
African American |
Kidney/5.6 |
No/No |
28 |
HTN, HLD, DM, CHF |
Cough, SOB |
Tacrolimus (trough 6 ng/mL), MMF 1000 mg TDD, prednisone 5 mg |
MMF held |
None |
Empiric ceftriaxone/doxycycline for CAP (cx negative) |
Discharged after 6 d |
6 |
56 |
White |
Kidney/14.2 |
No/No |
37 |
IgA nephropathy, colon cancer, HTN |
Cough, SOB, diarrhea, loss of taste/smell |
Tacrolimus (trough 13 ng/mL), prednisone 5 mg |
Tacrolimus dose reduced |
HCQ |
Empiric ceftriaxone/doxycycline for CAP (cx negative) |
Discharged after 2 d |
7 |
71 |
White |
Liver/19.4 |
No/No |
32 |
HTN, DM, CHF, seizures, Parkinson’s |
Fever, SOB, cough, confusion |
Tacrolimus (trough 3 ng/mL) |
None |
HCQ, azithromycin |
Encephalopathy, CKD, started HD during admission |
Discharged after 15 d |
8 |
76 |
Hispanic |
Liver/16 |
No/No |
31 |
DM, CHF, PTLD |
Recently discharged from SNF, syncope |
Tacrolimus (trough 3 ng/mL) |
None |
None |
Encephalopathy, empiric ceftriaxone for sepsis (cx negative) |
Discharged after 11 d |
9 |
56 |
White |
Kidney/ 23.4 |
No/No |
26 |
MI, seizure, stroke |
Fever, weakness, poor oral intake |
None (failed allograft) |
- |
None |
Severe depression |
Discharged after 13 d |
10 |
55 |
Hispanic |
Kidney/ 5.3 |
No/No |
22 |
HTN, psoriasis |
Fever, cough, SOB |
Tacrolimus (trough 5 ng/mL), MMF 2000 mg TDD, prednisone 5 mg |
MMF held |
Azithromycin, convalescent plasma |
Empiric vancomycin/cefepime (cx negative) |
Discharged after 8 d |
11 |
68 |
Hispanic |
Kidney/ 12.8 |
Yes/Yes |
29 |
DM, atrial fibrillation, stroke, seizure, vascular dementia |
Fever, cough, fall |
Tacrolimus (trough 3 ng/mL), MMF 1000 mg TDD, prednisone 5 mg |
None |
None |
Presented after fall at SNF, admitted CMO due to DNR/DNI/do not hospitalize order |
Deceased after 1 d |
12 |
61 |
Hispanic |
Kidney/ 4.5 |
No/No |
35 |
DM, HTN, sleep apnea |
Fever, cough, diarrhea, weakness, confusion |
Tacrolimus (trough 9.6 ng/mL), MMF 2000 mg TDD, prednisone 5 mg |
MMF dose reduced to 500 mg TDD, tacrolimus trough target reduced to 2-5 ng/mL |
HCQ, high dose hydrocortisone |
Superimposed pseudomonas pneumonia treated with cefepime, encephalopathy, severe ARDS |
Deceased after 31 d |
13 |
75 |
White |
Kidney/ 19.8 |
Yes/Yes |
29 |
HTN, DM, CHF, SAH, RA, Crohn’s disease, dementia |
Unknown—tested at SNF before admission |
Sirolimus (trough >20 ng/mL), prednisone 7.5 mg |
Sirolimus held |
None |
Became unresponsive d 2, stroke suspected, DNR/DNI transitioned to CMO |
Deceased after 2 d |
14 |
66 |
White |
Kidney/1.6 |
Yes/Yes |
19 |
HTN, HLD, Parkinson’s Crohn’s, PE, CVA, osteoporosis |
SOB, scratchy throat, COVID+ roommate at SNF |
Belatacept 5 mg/kg monthly, MPA 1440 mg TDD |
MPA held |
None |
SBO with no surgical option, DNR/DNI transitioned to CMO |
Deceased after 4 d |
15 |
56 |
African American |
Heart and Kidney/ 0.2 |
No/No |
17 |
HTN, HLD, DM, Non-hodgkin’s lymphoma, asplenia, stroke |
Routine screen preop for tracheostomy |
Tacrolimus (trough 7 ng/mL), prednisone 5 mg |
Reduced tacrolimus goal trough |
HCQ, azithromycin, high dose hydrocortisone |
Intubated x1 mo before COVID-19+, tested for screening before tracheostomy, numerous comorbid infections (BK, MRSA, VRE, Klebsiella/ Morganella, rotavirus), CVVH/HD, PEA arrest |
Deceased after 67 d |
16 |
70 |
White |
Kidney/ 22.4 |
No/Yes |
29 |
HTN, atrial fibrillation |
Fever, cough, SOB, hypoxia |
None (failed allograft) |
- |
Azithromycin, tocilizumab, convalescent plasma, high dose methylprednisolone |
Hyperactive delirium, DNR/DNI so not transferred to ICU |
Deceased after 1 d |