COVID-19 in elderly kidney transplant recipients

Crespo, Marta; Pérez‐Sáez, María José; Redondo‐Pachón, Dolores; Llinàs‐Mallol, Laura; Montero, María Milagro; Villar-García, Judith; Arias-Cabrales, Carlos; Buxeda, Anna; Burballa, Carla; Vázquez, Susana; Lopez, Thais Torralbo; Moreno, Fátima; Mir, Marisa; Outón, Sara; Sierra, Adriana; Collado, Sílvia; Barrios, Clara; Rodríguez, Eva; Sans, Laia; Barbosa, Francesc; Cao, Higini; Arenas, María Dolores; Güerri-Fernández, Roberto; Horcajada, Juan Pablo; Pascual, Julio

doi:10.1111/ajt.16096

Cited by 67 publications

(91 citation statements)

References 27 publications

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“…Our group promptly designed a protocol to limit the spread of the infection in its dialysis facilities that probably has influenced this low prevalence [ 16 ]. Regarding KT, (+)COVID-19 recipients were older than (−)COVID-19 ones, and the incidence reported is in line with other published data [ 17 , 18 , 19 , 20 , 21 ]. Cardiovascular disease, diabetes, chronic respiratory diseases, high blood pressure and cancer are the main risk factors described in COVID-19 [ 22 ] Nevertheless, in our population, no differences in pre-existing comorbidities were observed between COVID-19 confirmed and non-confirmed renal patients except that confirmed cases were most frequently obese.…”

Section: Discussionsupporting

confidence: 89%

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Clinical Profiles in Renal Patients with COVID-19

Arenas

Crespo

Pérez‐Sáez

et al. 2020

JCM

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The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.

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Section: Discussionsupporting

confidence: 89%

“…Although some earlier series suggested a good prognosis of COVID-19 in renal patients [ 38 , 39 ], recent reports show a worse outcome [ 10 , 11 , 12 , 13 , 17 , 18 , 40 ] and a higher mortality rate (16–40%) than that observed in the general population [ 41 , 42 ]. Our study confirms these findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profiles in Renal Patients with COVID-19

Arenas

Crespo

Pérez‐Sáez

et al. 2020

JCM

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“…Emerging evidence suggests that kidney transplant recipients are not at particularly high risk of acquiring the infection. Infection rates in our review range from 0.27% to 1.67%, with the highest rate of 5% reported in a study from Spain [ 56 ], in a cohort of elderly (>65 years) recipients. Of note, the infection rate among younger recipients in the same cohort was at 0.8%.…”

Section: Discussionmentioning

confidence: 72%

“…In 13 case series including more than 10 patients, CFR ranged from 6% up to 67%. The highest CFR was reported by Nair (U.S., 33%), Crespo (Spain, 50%), Abrishami (Iran, 67%), Akalin (U.S., 28%), and Bossini (Italy, 28%) [ 3 , 6 , 50 , 53 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

Marinaki

Tsiakas

Korogiannou

et al. 2020

JCM

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The coronavirus disease 2019 (COVID-19) pandemic has posed a significant challenge to physicians and healthcare systems worldwide. Evidence about kidney transplant (KTx) recipients is still limited. A systematic literature review was performed. We included 63 articles published from 1 January until 7 July 2020, reporting on 420 adult KTx recipients with confirmed COVID-19. The mean age of patients was 55 ± 15 years. There was a male predominance (67%). The majority (74%) were deceased donor recipients, and 23% were recently transplanted (<1 year). Most patients (88%) had at least one comorbidity, 29% had two, and 18% three. Ninety-three percent of cases were hospitalized. Among them, 30% were admitted to the intensive care unit, 45% developed acute respiratory distress syndrome, and 44% had acute kidney injury with 23% needing renal replacement therapy. From the hospitalized patients a total of 22% died, 59% were discharged, and 19% were still in hospital at the time of publication. Immunosuppression was reduced in 27%, discontinued in 31%, and remained unchanged in 5%. Hydroxychloroquine was administered to 78% of patients, antibiotics to 73%, and antivirals to 30% while 25% received corticosteroid boluses, 28% received anti-interleukin agents, and 8% were given immunoglobulin. The main finding of our analysis was that the incidence of COVID-19 among kidney transplant patients is not particularly high, but when they do get infected, this is related to significant morbidity and mortality.

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“…Short-term mortality in this study was 50% and is more pronounced in patients who had underlying cardiac disease, frail, and obese. 29 …”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Renal Transplant Patient Presenting With Active Typical Symptoms and Resolved Atypical Symptoms

Adapa

Konala

Naramala

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.

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COVID-19 in elderly kidney transplant recipients

Cited by 67 publications

References 27 publications

Clinical Profiles in Renal Patients with COVID-19

Clinical Profiles in Renal Patients with COVID-19

A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

COVID-19 in Renal Transplant Patient Presenting With Active Typical Symptoms and Resolved Atypical Symptoms

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