Dear Are, dear all
sorry for the late reply but these are strange days.
Firstly, I need to post a huge correction to my initial report; I apologise for my sentence wich was misleading. With reference to "initial treatment": we had asked our local pharmacy for Kaletra (which is not immediately available for every patient, we need to sign papers and then we receive it for each individual within 24-48 hrs), but in the end we decided NOT to admister this drug both because we were afraid of drug interactions and because of the recent evidence from the NEJM trial.
We decided instead to start h
ydroxychloroquine.
Paracetamol (acetaminophen) is currently enough to manage his temperature; his P/F on RA is in 390.
Secondly, for what concerns IST, we decided to temporarily hold eve, and leave him only on CS and tac.
We are currently keeping a registry including all the patients we are testing for COVID19.
In the last 48 hrs, we had another patient tested, who turned negative.
I would like also to add that our COVID patient (despite being extremely cautios, he never left his house since the end of February, practicing smart working and home sport) lives in the surroundings of two of the hardest hit cities in Lombardy (Brescia and Bergamo).
Finally, to answer dr. Karolak, we currently have no news regarding availability of serology testing for COVID19.
Kindest regards
Letizia
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Letizia Corinna Morlacchi, Respiratory Consultant
U.O.C. Pneumologia Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano
letizia.morlacchi@gmai.com------------------------------
Original Message:
Sent: 03-19-2020 05:08
From: Are Holm
Subject: Share your Experience with COVID-19
Dear Letizia,
Thank you for your report.
Could you please write something about why you choose Kaletra (lopinavir/ritonavir) and if you experienced any interactions with tac or eve? And also: did you continue Tac, eve and cs? (he was already not on MMF or azathio. , right?)
Finally: are you keeping a local registry of tx patients with COVID-19? It will be useful as number of cases increase.
Best regards,
Are Holm
(tx-pulmonologist, Oslo, Norway)
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Are Martin Holm, MD PhD
Associate Professor
Oslo University Hospital, Norway
Chair Scandiatransplant Heart and Lung Group
Original Message:
Sent: 03-18-2020 16:53
From: Letizia Corinna Morlacchi
Subject: Share your Experience with COVID-19
Dear all
I am a transplant pneumologist, writing from Milan, where we are facing this emergency since the last days of February.
We have just admitted one of our patients for COVID19 pneumonia. He is a 48 year old male and he received bilateral lung transplant for cystic fibrosis in April 2014. His graft was doing great till January (his last routine visit; his next visit was originally scheduled for April 2020): his FEV1 was 92% of predicted and 97% of best/baseline; excellent performance status. Baseline IST: CS + Tac + eve.
After a phone call, he was admitted to our ER for fever and malaise; no cough, no dyspnea, no cold. His swab turned positive; his blood test showed lymphocytopenia and mild increase of c-reactive protein. Although no significant alteration of gas exchange was founded, we decided to admit him at our UNIT because of his CT scan (bilateral patchy GGO). We started CPAP during the night for support. Initial treatment included Kaletra and antibiotic regimen with pip/tazo.
He is currently doing fine, but we are keeping him closely monitored.
I would also like to add that we had two other lung transplant recipients who were tested for COVID19 (but this happened in the last days of February, when the situation was much less dramatic) for URI; they both turned negative, but influenza virus was founded on their swabs and they received a course of oseltamivir. Hospital admission was not indicated (no pulmonary infiltrate, no respiratory distress/failure). They are currently doing fine.
I do hope we will be able to cope with this emergency.
Kindest regards. Stay safe.
Letizia
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Letizia Corinna Morlacchi, Respiratory Consultant
U.O.C. Pneumologia Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano
letizia.morlacchi@gmai.com
Original Message:
Sent: 03-13-2020 17:25
From: David Baran
Subject: Share your Experience with COVID-19
Colleagues,
We all devour research papers daily hungry for information about Covid-19 and transplant, but I believe that the ISHLT community must move quicker than that to save lives. Our hearts go out to our colleagues in China, Italy, South Korea and elsewhere who have borne the brunt of the pandemic thus far.
I would like to propose this thread for colleagues to post replies on the following topics (feel free to add)
PRESENTATION--- Chest xray initial pattern? Clinical tempo of deterioration. Only adults or do pediatric transplants develop significant illness
MANAGEMENT-- If a transplant "looks well" but has COVID-19-- do you admit? How often do these patients deteriorate and if so, is it sudden where they suffer by not being admitted?
TREATMENT-- Experience with antivirals (beyond trials)--- Ganciclovir? Treating inflammation with Tociluzumab, chloroquine?
Co-infection--- Does Influenza + or human metapneumovirus positive rule out COVID?
IMMUNOSUPPRESSION--- In Kidney forums, some recommend steroid only immunosuppression which is not practical for heart patients. What are people doing? Higher steroid, or cutting steroid off, holding MMF? Perhaps TAC Monotherapy (my bias)
Please share as we combat this terrible illness.
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David Baran, MD
Director, Advanced Heart Failure and Transplantation
Sentara Heart Hospital
Norfolk, Virginia
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