Comparing the First and Second Wave of COVID-19 in Kidney Transplant Recipients: An East-European Perspective

Abstract

<b><i>Background:</i></b> The present study examined whether patient characteristics, management, and outcome of kidney transplant recipients (KTx) with COVID-19 changed in the second versus the first pandemic wave. <b><i>Methods:</i></b> We reviewed all available data (demographics, medical history, comorbidities, therapeutic interventions, and outcome) on our KTx with COVID-19 during the first wave (March–September 2020, <i>n</i> = 33) and the second wave (October 2020–February 2021, <i>n</i> = 149) of the COVID-19 pandemic. <b><i>Results:</i></b> One hundred eighty-two out of our 1,503 KTx in active follow-up got COVID-19 during 12-month period, corresponding to a prevalence of 12.1%. No difference was found in age, gender distribution, comorbidities, body mass index, or baseline immunosuppression between the 2 COVID-19 waves. Bilateral COVID pneumonia was more frequent during the first wave. More KTx were managed as outpatients during the second wave (15 vs. 39%, <i>p</i> < 0.01). Calcineurin inhibitors were more sparingly reduced during the second wave, whereas antimetabolites were similarly reduced (91 vs. 86, <i>p</i> = ns). Admission to intensive care units was comparable between the first (27%) and second waves (23%). During the first wave, 8 out of 9 patients (89%) requiring intensive care died, whereas the mortality of the ICU patients in the second wave was 68% (23 deaths) (<i>p</i> = 0.2). The overall mortality was 24% during the first wave and 16% during the second wave (<i>p</i> = 0.21), while in-hospital mortality was identical between the CO­VID-19 waves (27%). Increasing age and poor allograft function were significant predictors of mortality. <b><i>Conclusions:</i></b> Most patient characteristics and outcome were comparable between the first 2 COVID-19 waves. More KTx were managed as outpatients without an overall negative impact on outcome.

A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India

“…In our study, we observed an overall patient mortality rate of 27.5% (43/156), similar to results reported previously by us [ 34 ] as well as studies conducted across several countries [ 12 , 19 , 21 – 23 , 28 , 30 , 45 , 65 – 70 ]. Mortality was significantly associated with ventilator requirement, ICU admission, the incidence of AKI, and the requirement of dialysis support.…”

“…Previous studies [ 12 , 19 , 21 – 23 , 28 , 30 , 45 , 65 – 70 ] have reported older age, anemia, low platelet count, higher total leucocyte count, kidney dysfunction as diagnosed by elevated serum creatinine, and blood urea, and CT score >15 and increased inflammatory markers (IL-6, procalcitonin, D-dimer, CRP, Ferritin, and LDH) as risk factors for mortality, which are also present in our study. Our analysis further shows that the increase in D-dimer and IL6 levels correlate with an increase in mortality and every 5-unit increase in IL6 levels increases mortality risk by 2.4%.…”

“…Our recent publication also reported a 27% mortality rate in KTRs with COVID-19, which increases to 44% in hospitalized patients and 100% in patients requiring ventilation [ 34 ]. Following the resurgence of COVID-19 in various countries, investigators have compared the epidemiology and disease outcomes between the first, second, and in some cases, third COVID-19 waves [ 21 , 25 , 33 , 35 – 54 ]. However, data on the effects of the second wave of COVID-19 on KTR patients and its comparison with the first wave scenario is limited and reveals diverging results [ 21 , 25 , 45 , 47 , 53 ].…”

“…Following the resurgence of COVID-19 in various countries, investigators have compared the epidemiology and disease outcomes between the first, second, and in some cases, third COVID-19 waves [ 21 , 25 , 33 , 35 – 54 ]. However, data on the effects of the second wave of COVID-19 on KTR patients and its comparison with the first wave scenario is limited and reveals diverging results [ 21 , 25 , 45 , 47 , 53 ]. Currently, only one single-center study has been reported from India that has retrospectively investigated the impact of the first and second waves of COVID-19 on KTR; however, the study duration of the second wave was limited to 31 st May 2021 [ 25 ].…”

Consequences of the first and secondCOVID‐19 wave on kidney transplant recipients at a large Indian transplant centre

“…The recent study from European transplant centre described similar mortality rates in both waves, which is similar to our report. 31 In their report, there was no difference in clinical spectrum except the significant high number of cases being managed as outpatients in the second wave. Older age and chronic graft dysfunction was associated with mortality similar to our study.…”