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Transpl Infect Dis. 2020;00:e13416. wileyonlinelibrary.com/journal/tid
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1 of 7
https://doi.org/10.1111/d.13416
© 2020 Wiley Periodicals LLC
Received:24June2020
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Revised:7J uly2020
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Accepted:9July2020
DOI : 10.1111/ti d.13416
ORIGINAL ARTICLE
Kidney transplantation during coronavirus 2019 pandemic at a
large hospital in Miami
Aditya Chandorkar1 | Ana Coro1,2 | Yoichiro Natori1,2 | Shweta Anjan1,2 |
Lilian M. Abbo1,2 | Giselle Guerra2,3 | Adela D. Mattiazzi2,3 | Lumen A. Mendez-Castaner2,3 |
Michele I. Morris1 | Jose F. Camargo1 | Rodrigo Vianna2,4 | Jacques Simkins1,2
1Division of Infectious Disease, Department
of Medicine, University of Miami Miller
SchoolofMedicineMiami,Miami,FL ,USA
2Jackson Health System, Miami Transplant
Instit ute,Miami,FL,USA
3Division of Nephrology, Department of
Medicine, University of Miami Miller School
ofMedicine,Miami,FL,USA
4Depar tment of Surger y, Univer sity of Miami
MillerSchoolofMedicine,Miami,FL,USA
Correspondence
Jacques Simkins, Division of Infe ctiou s
Diseases, Miami Transplant Institute
and Unive rsit y of Miami Miller Sch ool of
Medicine, 1120 NW 14th street, Miami, FL
33136,USA .
Email: jsimkins@med.miami.edu
Abstract
Background: Coronavirus 2019 (COVID-19) pandemic has resulted in more than
350 000 deaths worldwide. The number of kidney transplants has declined during
thepandemic.Wedescribeourdeceased donorkidneytransplantation (DDK T) ex-
perience during the pandemic.
Methods: AretrospectivestudywasconductedtoevaluatethesafetyofDDKTdur-
ingtheCOVID-19pandemic.Multiplepreventivemeasureswereimplemented.Adult
patients thatunderwent DDKTfrom 3/1/20to 4/30/20were included. COVID-19
clinical manifestations from donors and recipients, and post-transplant outcomes
(COVID-19 infections, readmissions, allograft rejection, and mortality) were ob-
tained.Thekidneytransplant(KT)recipientswerefolloweduntil5/31/20.
Results: Seventy-sixpatientsreceivedkidneysfrom57donors.Fever,dyspnea, and
coughwerereported in1,2,and1donor,respectively.Thirty-eight(66.6%)donors
were tested for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2)
priortodonation (mainlybynasopharyngeal or bronchoalveolarlavagepolymerase
chainreaction[PCR])and36(47.3%)KTrecipientsweretestedatthetimeofDDKT
by nasopharyngeal PCR; all of these were negative. Our recipients were followed for
amedianof63(range:33-91)days.Atotalof42(55.3%)recipientsweretestedpost-
transpla ntforSAR S-CoV2bynasophar yngea lP CRin cluding12patientsth atbe came
symptomatic;alltestswerenegativeexceptforonethatwasinconclusive,butitwas
repeatedandcamebacknegative.Forty(52.6%)KTrecipientswerereadmitted,and
7(9.2%)hadbiopsy-provenrejectionduringthefollow-up.NoneoftheKTrecipients
transplanted during this period died.
Conclusions: OurcohortdemonstratedthatDDKTcanbesafelyperformed during
theCOVID-19pandemicwhenpreventivemeasuresareimplemented.
KEYWORDS
COVID-19,kidneytransplant,PCR,safety,SARS-CoV2
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CHANDORK AR et Al.
1 | INTRODUCTION
InDecember2019,severalclustersofasevereacuterespiratoryill-
ness were described in Wuhan, China.1,2 These were the first cases
ofwhatwastolaterbecometheCoronavirus2019(COVID-19)pan-
demic. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-
CoV2), a novel beta-coronavirus, was identified as the causative
agent.1,2 While initial spread was limited to China, the first inter-
national case was confirmed in Thailand on January 13, 2020.1 By
January 30, 2020, the World Health Organization declared that the
outbreak was a public health emergency of international concern.3
AsofJune1,2020,theCOVID-19pandemichasbeenresponsi-
blefo r6 , 20 6,773c asesand372 ,752deathswo rldwide ,i n18 8c ou n-
tries and regions.4 The Unit ed States (US) has b orne the bru nt of
thepandemic,with nearly29%and28% ofall worldwidecasesand
deaths, respectively. In the state of Florida, most of the cases have
occurre d in South Flo rida. The C ounties of Miam i-Dade, Brow ard,
and Palm Beach alone have accounted for 55% of all cases and
deaths of the Sunshine State.5
Solidorgantransplant(SOT)recipientsfacesignificantriskfrom
respiratory viral infec tions as they tend to be more severe in the
immunocompromisedhost.Forexample,influenzainSOTrecipients
isassociatedwithpneumoniain14%-49%ofpatients6,7 and is com-
monly associated with subsequent viral, bacterial, and fungal pneu-
monia,withaco-infectionrateof7%-29%.8,9
Kidney tr ansplanta tion is a vital int ervention fo r patients wi th
end-stagerenaldisease(ESRD).Kidneytransplantationsignificantly
improves survival as it was demonstrated in a study that showed
thatthemortalityratewas48%-82%loweramongkidneytransplant
(KT) recipients compared withpeoplewho remained onlong-term
dialysis.10 The risk of hospitalization from infec tion is also lower in
KT recipients.11 In addition, kidney transplantation is associated
with significant improvements in patient satisfaction and quality
of life.12,13However,KTrecipientsareatahigherriskofcomplica-
tionsfromCOVID-19duetotheirdegreeofimmunosuppressionand
comorbidities.14,15Anobservationalstudyof36COVID-19-positive
KTrecipientsshowed78%ofpatientsrequiringadmissionand30%
requiring intubation with a 28% mortality at 3 we eks.14 Another
study from Italy revealed a rapid clinical and radiographic deteriora-
tionw it h2 5%m ort alityaf te ramedianperiodof1 5daysfromsymp-
tomonsetamongKTrecipient s.15
Inthisreport,we describeourexperienceinconductingkidney
transplants duringthe COVID-19pandemic at asingle, largetrans-
plant center located in the State of Florida.
2 | PATIENTS AND METHODS
2.1 | Study design
This is a single-center retrospective study conducted at Jackson
Memoria l-Miami Transpla nt Institute , a 1558-licensed b ed tertia ry
care teaching hospital in Miami, Florida. The study was approved by
the Institutional Review Board of the University of Miami. The main
objective of this study was to evaluate the safety of deceased donor
kidney transplantation (DDK T) duringthe COVID-19pandemic. All
the adult patients that underwent DDKT from 3/1/20 to 4/30/20
were included in the study and were followed until 5/31/20.
2.2 | Induction immunosuppression
The standard induction regimen in our institution is methylpredniso-
lone500mgIVdailyandanti-thymocyteglobulin(ATG)1mg/KgIV
daily(threedoseseach),andbasiliximab20mgIV(onpost-operative
days0and3or4).
2.3 | COVID-19 preventive measures
Since late January 2020, when thefirstcase of COVID-19was re-
ported in the United States, our hospital has implemented several
preventive measures to prepare for the upcoming crisis.
• Screening and appropriate triage of patients under investigation
forCOVID-19.
• Scaleuplocaltestingcapacity,especiallyin-housetestingtomeet
thedemandsduetotheincreasingnumberofCOVID-19cases.
• Screeningfor potential symptoms ofCOVID-19in ever y patient
admitted for transplant.
• Monitoring all SOT recipient s with a ver y low threshold to test
(andre -te stwheneve rnece ss ar y)forSA RS -CoV2withanasop ha -
ryngeal swab PCR test.
• Education of transplant candidates and recipients on the impor-
tance of maintaining social distancing, using adequate personal
protection,re ducingin-personvisitsiffeasible,u tilizingtelemedi-
cine applications for routine care visits if feasible and reducing the
numberofnon-essentiallaboratoryvisits.
• A separat e location was op ened in the tr ansplant clinic t o test
symptomatic transplant patients to avoid transmission to other
patients.
• The use of surgical mask in all the medical campus facilities was
made mandatory for all the healthcare workers and employees.
• Theentranceofnon-employeestoourhospitalwasrestric ted.
• The living kidney donor and kidney/pancreas programs were
placed on hold.
• High-risk population:patientsovertheageof75 years,patient s
between70and75years old withsignificant comorbidities, pa-
tients w ith HIV and sens itized patient s (unless crossma tch was
negative a nd no human leu kocyte antig en (HLA)- donor-specific
antibodieswerenotedonLuminex®)wereplacedonhold.
• Preemptive transplantation was also placed on hold unless the
patientswere veryclosetorequiredialysis(Glomerularfiltration
rateunder15mL/min).
• At the beginning of 4/2020, additional measures were imple-
mented inourDDKT program:Alldonors musttestnegative for
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CHANDO RKA R et Al.
SARS-CoV2andnotresideinCOVID-19hotspots,andrecipient s
musttes tnegativeforSA RS-CoV2uponadmissionfortransplant .
2.4 | Donors' demographics, clinical
manifestations, and SARS-CoV2 testing
DonorNet® was reviewed to obtain the donors' information. We
obtained epidemiological and travel history within 1 month prior to
donation. We investigated if donors had fever, cough, and dyspnea
before hospital admission by reviewing the medical-social ques-
tionnaire obtained from donors' relatives. We assessed the donors'
Chest X-rays (CXR)toevaluate for thepresenceofopacitiesorin-
filtrates. Findings suggestive of atelectasis, pleural ef fusion, and
pulmonary edema were not included. In addition, we evaluated if
the donors were tested forSARS-CoV2. The sample sources were
documentedforthosewho were screenedforSARS-CoV2.Please
notethatdonorswerenotalwaystestedforSARS-CoV2.Testingfor
SARS-CoV2was decided bytheOrgan ProcurementOrganizations
basedontestingavailability,donorhistory,andsuspicionforCOVID-
19.GeneFinder™COVID-19PlusRealAmpKit(runningtime:1hour)
byELITechGroupwasusedto testthe localdonors.16 The informa-
tion of the SARS-CoV2 polymerasechain reaction (PCR) plat forms
used to test the imported donors was not available.
2.5 | Recipients' demographics, clinical
manifestations, and SARS-CoV2 testing at the time of
transplantation
Th em e di c alcha r t sw erere vie we dtoob tai nd e mog rap hic s( age,g en -
der,ethnicity,andFloridaCountyofresidence),toevaluateiftheyhad
sym pto msofCOVID-19orabnor malCXRatt hetimeoft ransp lanta-
tion. Findings suggestive of atelectasis, pleural effusion, and pulmo-
nary edema were not included, same as donors. We investigated for
the following symptoms: cough, dyspnea, fevers, chills, chest pain,
fatigue, headaches, body aches, rhinorrhea, sore throat, conjunctivi-
tis, anosmia, dysgeusia, altered mental status, nausea/vomiting, ab-
dominal pain, and diarrhea. We also evaluated if they were tested for
SARS-CoV2atthetimeoftransplantation.GeneFinder™COVID-19
Plus RealAmpKit,Xpert®XpressSARS-CoV2(ru nni ngtime:4ho urs)
byCepheidandQI-Astat-DxRespirator ySARS-CoV2Panel(running
time:8hours)byQiagenwereavailableinourhospitaltotesttheKT
recipients during the study period. The tests were chosen at the dis-
cretion of the ordering providers. The clinical performance of these
threePCRplatformsisexcellent.16 -18
2.6 | Outpatient visits during post-transplant
follow-up
The total number of outpatient visits from discharge to end of fol-
low-up (5/31/20) was obtai ned to get a sense of how fre quently
patients were leaving home and getting potentially exposed to
COVID-19in case they werenot following the recommended pre-
ventivemeasures(eg,wearingmaskandmaintainingsocialdistance).
The outpatient visits include appointments with medical providers,
appointments for laboratories and imaging studies, outpatient pro-
cedures, andemergency depar tment(ED) visits. The telemedicine
appointments via ZOOM® went live on 3/30/20 and were also ob-
tained.Thecharts were reviewedto determineifany oftheKTre-
cipientsclaimedexposuretoCOVID-19.
2.7 | Post-transplant outcomes
Weevaluatedifanyof theKTrecipientsdevelopedCOVID-19dur-
ing the fol low-up period by r eviewing the ir chart s to determine i f
theydeveloped symptomsofCOVID-19,testedpositiveorweredi-
agnosed with COVID-19at anoutsidefacilit y.We investigatedfor
readmissions, biopsy-proven rejection,andmort alityby theendof
the follow- up period. Th e reasons for re admissions an d the treat-
ments used for allograft rejection were also obtained. We also as-
sessed if patients who were readmitted were more likely to be tested
forSARS-CoV2comparedwiththosewhowerenotreadmitted.
2.8 | Statistical analyses
Chi-squaretest wasused to assess bivariate associationsbetween
categorical variables; Median was used to assess continuous vari-
ables, basedonnormality ofthe distributions. Ap value < .05 was
considered significant.
3 | RESULTS
3.1 | General
Seventy-sixpatientsreceivedkidneyallograftsfrom57donorsfrom
3/1/20 to 4/30/20. Forty patients were transplanted in 3/2020 and
36in4/2020.ThedonorsandKTrecipientswereanalyzed.
3.2 | Donors' demographics, clinical
manifestations, and SARS-CoV2 testing
Twenty-five (43.9%) don ors were from Flor ida. The other don ors
werefromPennsylvania(11donors),California(4),Georgia(3),New
Jersey, Missouri, Delaware and Puerto Rico (2 each), Nebraska,
Illinois, Washington, Michigan, Connecticut, and Nevada (1 donor
each). None of the d onors had tr aveled within 1 mo nth prior do-
nation. Fever, dyspnea, and cough were reported in 1, 2, and 1
donor,respectively(Table1).CXRopacitiesorinfiltrateswerenoted
in 15 (26.3%) donors (Table 1). Thirt y-eight (66.6%) donors we re
tested for SARS-CoV2 byPCR from dif ferent sources (mainlyfrom
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CHANDORK AR et Al.
nasopha rynx and bron choalveolar lav age) (Table 2). All the dono r
SARS-CoV2testingcamebacknegative.
3.3 | Recipients' demographics, clinical
manifestations, and SARS-CoV2 testing at the time of
transplantation
Atotalof76patientsunder wentDDKTbetweenMarch1,2020and
April 30, 2020.The median age of the recipients was 54.5(range:
22-70) years. The majority of the KT recipients were Male (56
[73.7%]), Hispanic(42[55.3%]), andresided in Miami-Dade Count y
(53[69.7%]).Onlyonepatientwassymptomaticatthetimeoftrans-
plantation. She had cough from a resolving cold. Her CXR was nor-
mal,andshewasnottestedforSARS-CoV2atthetimeoftransplant.
Eight (10.5%) patie nts had opacit ies noted on CXR at t he time of
transplant(Table3).Atotalof 36(47.3%)KTrecipientsweretested
for SARS- CoV2 at the time of trans plantation by nas opharyngea l
PCR;allofthesewerenegative(Table3).Themedianlengthofhos-
pitalst aywas6.1(range:3.2-20.8)days.
3.4 | Outpatient visits during post-transplant
follow-up
All the KT recipient s visited the medical center during the follow-
upperiod(fromhospitaldischarge to5/31/20),75(98.7%) patients
for outpatient follow-up visits (median: 3 [range: 1-9] visits), 76
(100%) for labo ratory app ointments (med ian: 11 [range: 3-19] ap-
pointments),45(59.2%)for imagingstudiesappointments (median:
2 [1-4] appointment s), and 16 (21.1%) for procedures (median: 1
[1-3]procedures).Thirteen (17.1%)patientswenttotheEmergency
Departmentfornon-COVID-19reasons(10patientsonceandthree
patientstwice).Sixteen(21.1%)KTrecipientshadtelemedicinevis-
its (15patientsonceone patientt wice). None of theK Trecipients
claimedexposuretoCOVID-19duringthefollow-upperiod.
3.5 | Post-transplant outcomes
OurKT recipients were followedforamedian of63(range: 33-91)
days.NoneofourKTrecipientsdevelopedCOVID-19infectiondur-
ingthefollow-upperiod.Atotalof42(55.3%)recipientsweretested
forSARS-CoV2byanasopharyngealPCRincluding12patientsthat
became symptomatic (nausea/vomiting [4 patients], fevers, chills,
dy spn e a ,f a tig u e,a ndd iar r hea [3 each], abd o min a lp a in(2) ,an dhe a d-
achesandb odyaches[1patienteach]).Ofthe42patientsthatwere
tested,23(54.8%)weretestedonce,12(28.6%)twice,4(9.5%)four
times,and3(7.1%)sixtimes.Alltestscamebacknegativeexceptfor
one that was inconclusive, but it was repeated and came back nega-
tive. For ty (52.6%) KT recip ients were read mitted to the hos pital
during the follow-upperiod.There were atotal of55readmissions
(Table4).Seven(9.2%)KTpatientshadbiopsy-provenrejectiondur-
ingthefollow-up. The kidneybiopsies revealedborderlinechanges
“suspicious”foracuteTcell–mediatedrejection(5patients),acuteT
cell–mediated rejection IA-IIA (1 patient), and acute and chronic T
cell–mediatedrejectionIA(1patient).Therejectionwastreatedwith
steroidsinsevenpatients,ATGintwopatients,andintravenousim-
munoglobulin in three patients. Patients who were readmitted were
morelikelytobetestedforSARS-CoV2comparedwithpatientswho
were not rea dmitted [33/40 (82. 5%)v s. 9/27(33. 3%), P = <.0 01].
NoneoftheKTrecipient stransplantedduringthestudyperioddied
bytheendofthefollow-up.
4 | DISCUSSION
OurDD KTprogram,whic hp er formedth el ar gestnumberofK Td ur-
ing2019intheUnitedStates,19 has remained fully active during the
COVID-19pandemic.AreviewofUnitedNetworkforOrganSharing
TABLE 1 Demographics and clinical manifestations of the
donors
Variables N° 57 (%)
Demographics
Localdonors(Florida) 25(43.9)
Tra ve l sa 0
Symptoms
Feverb 1(1.8)
Dyspneab 2(3.5)
Coughb 2(3.5)
CXR opacities or infiltrates 15(26.3)c
Abbreviation:CXR,Chest-X-ray.
aNot specified in 25 donors .
bFever,dyspnea,andcoughwereunclearin9,13,and12donors,
respectively.
cBilateralopacities(6donors),unilateralopacities(4),bilateralinfiltrates
(2),andunilateralinfiltrates(3donors).
TABLE 2 SARS-CoV2testingofthedonors
SARS-CoV2 testinga
Donors
N° 57 (%)
Nasopharyngeal PCR 14(24.6)
Bronchioalveolar lavage PCR 14(24.6)
Bronchioalveolar lavage and plasma PCR 2(3.5)
Bronchioalveolar lavage P CR and unclear source 2(3.5)
Nasopharyngeal PCR 2(3.5)
Nasopharyngeal and plasma PCR 1(1.8)
Nasopharyngeal and bronchioalveolar lavage PCR 1(1.8)
Nasopharyngeal, right and lef t kidney biopsy P CR 1(1.8)
KidneybiopsyPCR 1(1.8)
Abbreviations:PCR,polymerasechainreaction;SARS-CoV2,Severe
AcuteRespirator ySyndromeCoronavirus2 .
aAlltest swerenegative.
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(UNOS)datashowedthesignificantimpactofCOVID-19pandemic
on kidney transplantation in the United States. The total number of
kidney transplants decreased from approximately 475-525 trans-
plants a week prior to the pandemic to a nadir of 213 transplants in
a week at the height of the pandemic, with living donor transplants
decreasing to near zero numbers.20 The mortality benefit af forded
by transplantation and the sheer volume of patients on the wait-
ing list make it imperative to avoid suspension of transplantation
programsacross the countr y whenever possible. AsofJune 2020,
there were over 101,00 0 patients on the kidney transplant waitlist.
In2019,3,923patientsdiedwhilewaitingforakidneytransplant.20
In addition, kidney transplantation could theoretically reduce risk of
COVID-19exposureasSARS-CoV-2transmissionhasbeenreported
in dialysis units.21
In this retrospective, single-center cohort study, wed escribed
our DDKT experience during the pandemic. Infection preventive
measures, which were highlighted in the Patient and Methods sec-
tion, wereimplemented from thebeginning of the COVID-19pan-
demic. Note, that our COVID-19 policies are updated as needed
after multidisciplinary discussions with transplant nephrologists,
surgeons, infectious diseases and infection control specialists and
pharmacists.
In a COVID-19/SOTprotocol from BaylorCollege of Medicine,
transplant candidates must have hadanegativeSARS-CoV2naso-
pharyngeal swabandnormalchest computed tomography (CT )for
COVID-19toproceedtotransplant.22 The need for chest CT in as-
ymptomatic patient s admitted for SOT should be carefully evaluated
asithaslowspecificityforCOVID-19.23
Our cohor t included 76 pati ents that safe ly underwe nt DDKT
inMarch-April2020inspiteoftheCOVID-19pandemic.Morethan
40% ofourdonorswerefromFlorida andby March31standApril
30th (s tudy end date fo r donation), ther e were 6338 and 33 690
confirmed cases in Florida, respectively.24,2 5NoneofourKTrecipi-
entswerediagnosedwithCOVID-19duringamedianfollow-uptime
ofapproximately2months eventhough the majority(70%)resided
inM iami-Da deCo un ty(mos taff ec te dF lo ri daCounty byCOVID-19),
andtheyhadtoleavehomeonmultipleoccasionsforfollow-upvis-
its,laboratory appointments,etcBytheendofthestudyfollow-up
(May31st),therewere56163 confirmedcases inFloridaincluding
18000 inMiami-DadeCounty.26 These numbers would have been
considerablyhigherifmorepeoplewouldhavebeentested.Around
halfofourKTrecipient swerereadmit tedduringthefollow-uppe-
riodbutnoneofthemwereadmittedspe cific allytoruleoutCOVID -
19.Interestingly,theKTrecipientswhowerereadmittedweremore
likelytobetestedforSARS-CoV2thanpatientswhowerenotread-
mitted.Inaddition,thereweremorepatientstestedforSARS-CoV2
than symptomatic patients. Therefore, it seemed that many asymp-
tomaticKTrecipientswerescreenedforSARS-CoV2duringthefol-
low-upperiodatthediscretionofclinicians.
Blood transfusion transmission and donor-derived COVID-19
have not been reported but they could theoretically occur as viral
RNA has be en detected i n serum in patie nts with sever e COVID-
19. 27, 2 8S ARS- C oV 2h asa lsob een iso l at e di n uri ne29 bu t transmission
through k idney transpla ntation has not be en proved. SARS- CoV2
was not detected among our donors. However, one third of them
were not tested. Performing plasma and urine SARS-CoV2 PCR
couldbeconsideredamongKTrecipientswhenthereisconcernfor
donor-derive d COVID-19or wh en donors ar e from COVID-19h ot
TABLE 3 Demographics,radiographicfindings,andSARS-CoV2
testing of kidney transplant recipients at the time of transplant
Variables N° 76 (%)
Gender(male) 56(73.7)
Ethnicity
Hispanic 42(55.3)
AfricanAmerican 27(35.5)
Othersa 7(9.2)
County of residence
Miami-Dade 53(69.7)
Broward 12(15.8)
Palm beach 7(9.2)
Othersb 4(5.3)
CXR opacities or infiltratesc 8(10.5)d
SARS-CoV2TestingbynasopharyngealP CR 36(47.3)e
Abbreviations:CXR,Chest-X-ray;PCR,polymerasechainreaction;
SARS-CoV2,SevereAcuteRespirator ySyndromeCoronavirus2.
aCaucasian(6patients)andA sians(1).
bSt.Lucie,Orange,Monroe,andCollierCounties(1patienteach).
cCXR not done in 6 recipients.
dBilateralopacitiesandunilateralopacities(4patientseach).
eAlltest swerenegative.
TABLE 4 Readmissionsduringthefollow-upperiod
Causes of readmissions 55 (%)
Worseningcreatinine(otherthanrejection) 8(14.5)
Allograftrejection 6(10.9)
Hematologic 7(12.7)a
Infections 7(12.7)b
Deep vein thrombosis or arteriovenous fistula
thrombosis
3(5.5)
Perinephric collection 4(7.3)
Hyperkalemia 3(5.5)
Odynophagia or dysphagia 3(5.5)
Leukocytosis 2(3.6)
Gastrointestinalbleeding 2(3.6)
Others 10(18.1)c
aSymptomaticanemia(6patient s)andhemolysis(1patient).
bClostridioides difficile(2patients),andurinar ytrac tinfec tion,surgical
wound infection, epididymitis, Staphylococcus epidermidis bacteremia,
and donor culture positive for Rhizopus(1patienteach).
cSmall bowel obstr uction, bradycardia, chest pain, diabetic ketoacidosis,
dizziness, diarrhea, abdominal pain, acidosis, dyspnea, and carvedilol
overdose(1patienteach).
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CHANDORK AR et Al.
spots,butitshouldbeinvestigated.In-hospitalCOVID-19transmis-
sionhas been reported.Inasingle-centerstudyfromWuhan, 41%
patientswerethoughttohaveacquiredCOVID-19inthehospital.30
Webelievethatthein-hospitalexposureprobabilityinourcenteris
lowgivenallthepreventivemeasuresthatwereenforced.In-hospital
COVID -19transmissioncanbeeasilyprevente dthroughbasicinfec-
tion control measures such as wearing surgical masks and perform-
ing hand and environmental hygiene.31 Our study demonstrates that
aDDKTprogramcanremainactiveduringtheCOVID-19pandemic
aslongastheCOVID-19preventivemeasuresarefollowedstrictly,
andthehospitalisnotatthemaximumcapacity.
This study has several limitations. First, it is a retrospective
study. Therefore, we could have missed clinical data, such as symp-
tomsofCOVID-19amongourKTrecipients.Second,oursamplesize
wasrelativelysmall,andthestudyfollow-uptimewasnottoolong.
The number of COVID-19cases increased in Florida inJune 2020
sowecouldhaveidentifiedCOVID-19casesamong our patients if
they would have been followed longer. Lastly, this study includes
alltestingperformedatourcenterandpotentiallyexcludespositive
tests performed at other facilities. In conclusion, our cohort demon-
strate d that DDK T can be safel y perfor med during t he COVID-19
pandemic when preventive measures are implemented and fol-
lowed.Largerstudieswithalongerfollow-upareneededtoconfirm
our encouraging results.
AUTHORS' CONTRIBUTIONS
A. Cha ndorkar. involved in s tudy design, da ta analysis/inte rpreta-
tion, draftingarticle, critical revision of ar ticle.A.Coro. involvedin
data analysis/interpretation and critical revision of ar ticle. YN in-
volved in data analysis/interpretation and critical revision of article.
S.A involved in data analysis/interpret ation and critical revision of
article. LMA involved in data analysis/interpretation and critical
revision ofarticle. GG involved in data analysis/interpretation and
criticalrevisionofarticle.ADMinvolvedindataanalysis/interpreta-
tion and cr itical rev ision of art icle. LA M involved in dat a analysis/
interpretation and critical revision of article. MIM involved in data
analysis/interpretation and critical revision of article. JFC involved
indataanalysis/interpretationandcriticalrevisionof article. RVin-
volved in data analysis/interpretation and critical revision of article.
JS involved in study design, data analysis/interpretation, drafting ar-
ticle, and critical revision of article.
ORCID
Yoichiro Natori https://orcid.org/0000-0002-4938-125X
Jose F. Camargo https://orcid.org/0000-0001-9584-5011
Jacques Simkins https://orcid.org/0000-0001-9626-0760
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How to cite this article:ChandorkarA,CoroA,NatoriY,
etal.Kidneytransplantationduringcoronavirus2019
pandemic at a large hospital in Miami. Transpl Infect Dis.
2020;00:e13416. http s://doi.org/10 .1111/tid .13 416
