Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

Abstract

The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.

Enhanced Humoral Immune Response After COVID-19 Vaccination in Elderly Kidney Transplant Recipients on Everolimus Versus Mycophenolate Mofetil–containing Immunosuppressive Regimens

“…1,2 The coronavirus disease 2019 (COVID-19)-associated mortality risk in this population is very high: approximately 23% for kidney transplant recipients (KTRs) of 65 y and increasing with 3.7% for every 10 y of age. 3 Vaccination is a very effective way to prevent a severe course of COVID-19 infection in the general population. 4,5 Unfortunately, several studies have shown that the seroconversion rates after 2 COVID-19 mRNA vaccinations are relatively low in KTRs, with percentages varying between 4% and 57%.…”

“…1 , 2 The coronavirus disease 2019 (COVID-19)–associated mortality risk in this population is very high: approximately 23% for kidney transplant recipients (KTRs) of 65 y and increasing with 3.7% for every 10 y of age. 3 …”

Impact of COVID-19 on Global Kidney Transplantation Service Delivery: Interim Report

“…In 2021, COVID-19 infections were managed similarly in kidney transplant recipients and in the general population ( 49 , 50 ), although transplant recipients had heightened risk of poor outcomes ( 51 ). Given the risks inherent in commenting on any single publication, the authors encourage regular review of guidance from the US National Institutes of Health ( 47 ) and the European Medicines Agency ( 52 ).…”

Impact of the COVID-19 Pandemic on Global Diseases and Human Well-Being

“…In fact, the authors demonstrated increased rates of adverse outcomes among transplanted patients: mortality—21%; admission to intensive care units—26%; intensive mechanical ventilation among those who required admission in intensive care units—72%; acute kidney injury—44%; kidney replacement therapy—12%; and graft loss—8%. Moreover, a higher risk of mortality for elder patients has been registered too [ 9 ].…”