I am Associate Professor of Surgery and Associate Dean for Faculty Affairs and Professional Development at the University of Maryland School of Medicine in Baltimore, MD, USA. I have been a kidney and pancreas transplant surgeon since 2012, having completed medical school at UAB, followed by residency and fellowship training at the University of Wisconsin - Madison (go UW solution!). I also have an interest in dialysis access. I have dabbled in basic science research, and while I LOVE learning about immunology, doing the research work did not capture my attention as well as clinical medicine. I am very much a people person, and I have benefited tremendously from the help of all my mentors (too many to name and I would forget some) and sponsors. In turn, I love to help others - whether patients or students or trainees or junior faculty - in whatever way I can. I think that's why I focused on policy development working with UNOS, and on helping other faculty succeed in their careers in my role as Associate Dean, rather than pursuing research. It's a busy life, but it fits me. I also am different in that I've been the lucky recipient of 2 kidney transplants - one at age 11 in Germany (by a Professor Dr. Klaus Moehring), and one at age 42 at the University of Maryland (that way I could tell my surgeon exactly what to do and what not to:). I think that has led me to be (intentionally or not) an advocate for other patients whenever possible. I look forward to meeting new people at TTS 2022!
COVID-19 infection after pancreas transplantation
Silke Niederhaus1, Nadiesda Costa2, Kapil K Saharia3.
1Surgery, University of Maryland School of Medicine, Baltimore, MD, United States; 2Medicine, Georgetown University, Washington, DC, United States; 3Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
Introduction: Transplant recipients are at elevated risk of COVID-19 infections. Pancreas transplant recipients (PTR) are an understudied group. We wanted to determine COVID-19 vaccination, infection, and breakthrough infection rates in PTR.
Materials and Methods: We performed a retrospective review of 176 PTR performed between 1/1/2014-2/1/2022. Summary data are presented as mean+/-standard deviation. Bivariate comparisons to evaluate characteristics associated with outcomes were performed using Fisher's exact test.
Results and Discussion: The mean age at transplant was 45.3+/-9.1 years, and the mean current BMI 27.9+/-5.6. There were 95 (53%) males, 90 (50.3%) were white, 68 (38%) black, 8 (4.5%) Asian, and 10 (5.6%) others. The majority were SPK recipients (140, 78%). During a mean of 1228+/-687 days of follow-up, there were 12 organ failures (8 P, 2 K, 2 SPK). Of patients who developed a COVID infection, only 2 (3%) patients died (with functioning grafts) from COVID infection. Both were fully vaccinated with 2 and 3 doses, respectively. A third patient died from unrelated causes. 138/176 (78%) PTR were fully vaccinated (>=2 doses of mRNA vaccine), 35 patients remain unvaccinated; 3 had only one dose of vaccine. Among the unvaccinated or partially vaccinated group, 13/38 (34%) patients developed COVID-19 infection. In vaccinated patients, 44/138 (32%) patients developed infections, at a mean of 160+/-94 days after the most recent vaccine dose prior to the infection, or 216+/-75 days after being fully vaccinated. Table 1 shows the distribution of infections by number of vaccines. Among post-transplant infections, 11 occurred during the ancestral wave; 7 during the alpha/beta/gamma wave (December 2020-May 2021), 7 during the delta wave (May 2021-December 2021), and 32 occurred during the omicron wave (December 2021-now).
Interestingly, among PTA and SPK recipients, 45 of 150 patients developed post-transplant COVID infection (30%), whereas in the PAK/other group, there were 12 infections in 26 recipients, for a rate of 46% (p=0.06).
Conclusion: In summary, PTR were vaccinated to a similar degree compared to the general population. Infection rates were similar between vaccinated and unvaccinated PTR. To date, COVID-19 infections occurred in about 33% of PTR. PAK and other/multiple re-transplant recipients had a higher rate of infection compared to recipients of a PTA or SPK. Vaccination alone did not prevent death in 2 recipients. Ongoing precautions, including masking, continue to be advisable.
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