Assessment of clinical outcomes in renal transplant recipients with COVID‐19

Abstract

The coronavirus disease 2019 (COVID‐19) has affected more than a hundred million individuals and caused more than three million deaths worldwide. Specific risk groups were defined for increased risk of mortality and morbidity in COVID‐19, and renal transplant recipients are at a significantly increased risk regarding outcomes due to their immunosuppressed conditions. This study evaluated the general characteristics of kidney transplant recipients with COVID‐19 infection. Among 1257 transplant cases, 56 had COVID‐19 infection, and 23 (41%) were hospitalized during the 9‐month study period. Among all COVID‐19 cases, 58% were male with a mean age of 45.5 (±13.2, 19–71) years, and the most frequent comorbidities were hypertension (70.9%) and diabetes (23.6%). Hospitalized patients were older ( p = 0.03) and had higher rates of hypertension ( p = 0.008), diabetes ( p = 0.002), and ischemic heart disease ( p = 0.03). Therapeutic management included antimetabolite withdrawal and prednisolone increase in 71%, calcineurin inhibitor withdrawal in 8% and decrease in 58%, hydroxychloroquine in 17%, tocilizumab in 3%, and antivirals in 67% of patients. Acute kidney injury and respiratory failure developed in 34% and 85%, respectively. The mortality rate was 23%. These results emphasized that the COVID‐19 infection in renal transplant recipients significantly increases the risk of morbidity and mortality. Therefore, these patients should be intervened earlier and monitored closely to prevent poor outcomes.

Convalescent plasma treatment for SARS-CoV-2 infected high-risk patients: a matched pair analysis to the LEOSS cohort

“…A meta-analysis from Belsky et al, reviewed the disease course of immunodeficient patients infected by SARS-CoV-2 and found that solid organ transplant patients, who suffer from multiple comorbidities, are more likely to require intensive care, which is a surrogate for mortality 4 . E.g., in our cohort 7 patients with previous kidney transplantation had a mortality rate of 28.6%, in accordance to our results, Alberici et al, Yilmaz et al and Akalin et al found mortality rates of 28%, 23% and 25% in kidney transplant recipients with COVID-19 [29][30][31] . However, the mortality rate in our cohort was lower than in LEOSS patients with prior renal transplantation and CP therapy (45.5%).…”

“…On the other hand, a compromised immune response to the pathogen due to immunosuppression may also protect against the organ destroying cytokine storm caused by SARS-COV-2 and lead to a favourable outcome 32,33 . But the study of Minotti et al included mostly children or adults with rare immunodeficiencies in contrast to our cohort 33 4,28,30,31 . But they reported smaller case series and all patients had the same underlying disease.…”

Acute Kidney injury and COVID-19 infection

“…As the mortality rate is higher in patients who are receiving immunosuppressive drugs, therefore calcineurin inhibitor and antimetabolite withdrawal or dose decreasing are recommended for COVID-19 patients [65].…”

Association of the novel CROW-65 risk score and mortality in hospitalized kidney transplant recipients with COVID-19

“…Firstly, due to the chronic immunosuppressive therapy and ensuing suppression of cellular immunity, this population is at higher risk of viral infections [5]. Secondly, chronic immunosuppressive therapy has various immunomodulatory effects and could impair with the immunologic response during COVID-19 [5,[13][14][15]. Furthermore, frailty and susceptibility for recurrent kidney impairments during any infection portends these patients to adverse events.…”

“…Furthermore, frailty and susceptibility for recurrent kidney impairments during any infection portends these patients to adverse events. Increased cardiovascular risk, anemia, fluid imbalance, electrolyte disorders, and other companions of CKD could additionally impact the prognosis of these patients [14].…”