COVID-19 Infection in Kidney Transplant Patients: An Italian One Year Single Centre Experience

Abstract

COVID-19 is a life-threatening infection among elderly patients, comorbid patients, or transplanted patients. Lombardy (region of Italy), accounts for 786,324 cases as of 21 April 2021. We retrospectively describe our single Centre experience in 82 adult kidney-transplant patients with COVID-19 infection during two pandemic outbreaks: 27 (first outbreak) and 65 (second outbreak). Thirty-seven patients were hospitalized (HP) and sixty-five were home managed (HM). Infection presented with fever (80%), cough (51%), and dyspnea (33%). HP were older (60 ± 11 vs. 50 ± 14 years, p = 0.001), had more severe respiratory symptoms (dyspnea 62.1%, p < 0.0001–cough 67% p = 0.008), and a longer length of disease (30 ± 28 vs. 21 ± 10, p = 0.04). The incidence of acute kidney injury (AKI) was 29.7% (p < 0.0001). Steroid dosage was increased in 66% of patients (p = 0.0003), while calcineurin inhibitors were reduced by up to one third in 45% of cases, p < 0.0001. Eleven patients died (13%). HM patients recovered completely without sequelae. In the overall cohort, AKI development (p = 0.006 OR 50.4 CI 95% 3.0–836) and age (p = 0.04 OR 1.1 CI 95% 1.0–1.2) were the most important factors influencing the probability of death during the infection. Although we report a relatively low incidence of infection (5.1%) the incidence of death is almost four times higher than it is in the general population.

Vitamin D Status and SARS-CoV-2 Infection in a Cohort of Kidney Transplanted Patients

“…We think that the main limitations of the present study are the retrospective design and the relatively small sample size, even if we report one of the highest number of kidney transplanted patients with SARS-CoV-2 infection in a single center [7]. Of course, future prospective clinical trials, obviously not desirable considering the explored topic, might better explain the potential role of 25(OH)D in modulating SARS-CoV-2 infection in this group of patients.…”

“…Chronic kidney disease (CKD) and kidney transplant (KTx) are conditions associated with vitamin D deficiency and increased incidence of SARS-CoV-2 infection and mortality related to COVID-19 [5][6][7][8][33][34][35].…”

“…Patients with chronic kidney disease (CKD) and kidney transplantation (KTx) have high rates of vitamin D deficiency, for several reasons, such as steroid therapy and increasing age at transplantation [5,6]. Furthermore, KTx patients (KTxp) are at high risk of SARS-CoV-2 infection incidence and severity [7,8].…”

How Vaccinations Changed the Outcome of COVID-19 Infections in Kidney Transplant Patients: Single-Center Experience

“…All of them were included in this analysis. The diagnostic criteria for a suspicion of COVID-19 infection were the same as previously reported [ 1 ]. The certainty of diagnosis was based on the positivity of either the antigenic or molecular nasopharyngeal COVID-19 tests.…”

“…Kidney transplant recipients are a vulnerable population at risk of a life-threatening COVID-19 infection. During the previous pandemic outbreaks until April 2021, we reported—in our Centre—an incidence of death (13%) almost four-times higher than in the general population, in the presence of a low, but possibly underestimated incidence of infection (5.1%) [ 1 ]. This could be due to the reduced immunological response associated with the immunosuppressive therapy responsible for the impaired immune response to messenger RNA (mRNA) vaccines, including the COVID-19 vaccine [ 2 ].…”