Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India

Abstract

Background. There is a scarcity of data on the consequences of coronavirus disease-19 (COVID-19) infections in kidney transplant recipients (KTRs) from emerging countries. Methods. Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donors) with polymerase chain reaction-confirmed COVID-19 positivity from March 23, 2020, until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment, and outcomes. Results. Median age of transplant recipients was 43 years, and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%) and diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%), and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), and moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age; dyspnea; severe disease; obesity; allograft dysfunction before COVID-19 infection; acute kidney injury; higher levels of inflammatory markers including C-reactive protein, interleukin-6 level, and procalcitonin; chest X-ray abnormality, and intensive care unit/ventilator requirements. Overall patient mortality was 11.6% (29 of 250), 14.5% (29 of 200) in hospitalized patients, 47% (25 of 53) in intensive care unit patients, and 96.7% (29 of 30) in patients requiring ventilation. KTRs with mild COVID-19 symptoms (n = 50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic. Conclusions. Mortality rates in COVID-19-positive KTR appear to be higher than those in nonimmunosuppressed patients, and high mortality was noted among those requiring intensive care and those on ventilator.

COVID-19 after kidney transplantation: Early outcomes and renal function following antiviral treatment

“…Although the median age of the patients appears slightly lower than in other reports, the overall patient profile in terms of comorbidities and sex distribution appears to be similar to other reports (Felldin et al, 2021;Lubetzky et al, 2020). The overall outcomes of this first Eastern European cohort of transplant patients are comparable to those of patients in other single-centre reports or registry analyses, and this further suggests the existence of yet unidentified risk factors particular to this patient group (Caillard et al, 2020;Felldin et al, 2021;Hoek et al, 2020;Hillbrands et al, 2020;Kute et al, 2020;Nair et al, 2020).…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…11 Studies from Spain and India reported a similar incidence of AKI in kidney transplant recipients with COVID-19 (47% and 48%, respectively). 7,9 Favà et al reported that AKI stage 3 was associated with increased mortality, but no patients had acute graft rejection during a 2-week follow-up period. 9 In contrast, Kute et al reported 4.8% graft loss after 28-day follow-up, which occurred in patients with baseline chronic kidney disease.…”

“…9 In contrast, Kute et al reported 4.8% graft loss after 28-day follow-up, which occurred in patients with baseline chronic kidney disease. 7 Interestingly, 20 patients screened positive for donor-specific antibodies, of which 10 had de novo antibodies-this was thought to be related to reduced immunosuppression during COVID-19 treatment. 7 Risk factors associated with kidney transplant recipients' mortality include age, [7][8][9][10][11] disease severity, dyspnea, and ARDS.…”

“…7 Interestingly, 20 patients screened positive for donor-specific antibodies, of which 10 had de novo antibodies-this was thought to be related to reduced immunosuppression during COVID-19 treatment. 7 Risk factors associated with kidney transplant recipients' mortality include age, [7][8][9][10][11] disease severity, dyspnea, and ARDS. 7,9 There are conflicting data on the difference in outcomes for patients with recent transplants (within 1 year) versus those transplanted more than 1 year before infection; some report no difference, 8,11 and others report higher mortality in the first year of transplant.…”

“…7 Risk factors associated with kidney transplant recipients' mortality include age, [7][8][9][10][11] disease severity, dyspnea, and ARDS. 7,9 There are conflicting data on the difference in outcomes for patients with recent transplants (within 1 year) versus those transplanted more than 1 year before infection; some report no difference, 8,11 and others report higher mortality in the first year of transplant. 12 Several multicenter studies evaluated the effect of immunosuppression on outcomes from COVID-19, none of which found an association between immunosuppression and mortality from COVID-19.…”