COVID-19 infection in kidney transplant recipients (original) (raw)
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Early experience with COVID-19 in kidney transplantation
Kidney International, 2020
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A Retrospective Study on Kidney Transplant Recipients Diagnosed with COVID-19
AİBÜ İzzet Baysal tıp fakültesi dergisi, 2023
Objective: Solid organ transplantation may cause a predisposition to coronavirus disease-2019 (COVID-19) infections. In the present study, it was aimed to investigate the outcomes of kidney transplant recipients diagnosed with COVID-19. Materials and Methods: In this retrospective cohort study, files of 1034 kidney transplant recipients from one center were reviewed. 95 of these patients had contracted COVID-19 between March 1, 2020, and March 31, 2021. In this context, patients were divided as survivors and non survivors. Statistical analysis was performed with a student-t test and p<0.05 was accepted as the threshold of significance. Results: Related 95 patients with COVID-19, were males (58 (61%)). The mean age of all patients was 48.6 ± 11.2 years, and 31 of these patients had received cadaveric transplants (32.6%). Most symptoms were seen in similar frequency in the two groups, with fever in 31%, cough in 39%, myalgias in 59%, and diarrhea in 20%. On the other hand, while only 24% of the survivor group experienced dyspnea, all of the non-survivor group had dyspnea (p<0.05). Mortality was 12.6% (12 patients). Non-survivors were older (55.89 ± 6.99 vs 47.56±11.33 years; p<0.05), in terms of a higher body mass index (28.8 ± 5.5 vs 25.5 ± 5.0 kg/m2; p< 0.05), more frequently having diabetes (50% vs. 30%; p< 0.05), with longer hospitalization durations (8.5 ± 10.6 vs 3.05 ± 5.93 days; p<0.01) than survivors. Besides, leukocytosis (15.24 ± 8.80 vs 7.13 ± 3.39 /mm3), increased liver function tests (ALT and AST (632 ± 1041 and 2722 ± 4662 vs 22.8 ± 16.8 and 23.3 ± 12.6 (U/L) p<0.001), increased ferritin (2301.3 ± 1349.1 ng/ml vs 898.4 ± 1007.6 ng/ml, p< 0.05), increased lactate dehydrogenase (554±305 vs 252±130 mg/dl, p<0.001), increased procalcitonin (1.310±1.285 vs 0.108±0.105 ng/ml, p<0.001) were more frequent in non-survivors. Estimated glomerular filtration rate levels were lower (11.12 ± 1.89 vs 50.75 ± 21.99 ml/min, p<0.05). Hemodialysis was required for all non-survivors and 2% of survivors. Survival was significantly lower in patients with cadaveric transplants (Kaplan Meier analysis; p<0.05). Conclusion: Renal transplant recipients with COVID-19 experienced had an increase in terms of acute kidney injury and mortality in the present study. Furthermore, mortality was higher in cadaveric patients.
Transplantology
Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers, however, have adopted an early antimetabolite withdrawal in addition to other interventions. The epidemiological problem concerns also dialysis patients and waitlisted patients who have a higher COVID-19 infection diffusion with respect to kidney transplant recipients. Several factors influence mortality among kidney transplant recipients. Among these factors are the age, race, and comorbidity factors, such as hypertension, diabetes mellitus, obesity, and previous respiratory problems. Treatment is still limited. The only effective antiviral drug is remdesivir that should be administered before the development of the cytokine storm. Vaccination seems to be useful, but due to the concomitant immunosuppression ...
International Journal of Nephrology, 2021
Introduction. Experience of COVID-19 in kidney transplant recipients (KTRs) with clinical presentation, management, factors influencing mortality, and antibody response is limited. Material and Methods. A retrospective data of COVID-19 in KTRs was collected and analyzed. The mortality rate, risk factors, and antibody response were primary objectives, while the clinical presentation, laboratory indicators, and pharmacological management were secondary objectives. Results. The 67 KTRs with polymerase chain reaction (PCR) confirmed COVID-19 infection reported between 1 May 2020 and 31 December 2020; 61.2% of patients were hospitalized; and 20.9% needed ventilation. The overall mortality was 26.9%, while blood group A had 50% mortality. The treatment options and used were steroids (100%), convalescent plasma (32.8%), ivermectin (58.2%), doxycycline (55.2%), remdesivir (34.3%), tocilizumab (10.4%), antibiotics (61.2%), anti-fungals (26.9%), low molecular weight heparin (45.3%), and oral ...
BMC Nephrology
Background Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. Methods Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoint...
COVID‐19 and kidney transplantation: Results from the TANGO International Transplant Consortium
American Journal of Transplantation, 2020
Kidney transplant recipients may be at a high risk of developing critical coronavirus disease 2019 (COVID-19) illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the United States, Italy, and Spain who tested positive for COVID-19. Clinical presentation, laboratory values, immunosuppression, and treatment strategies were reviewed, and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9845 kidney transplant recipients across centers, 144 were hospitalized due to COVID-19 during the 9-week study period. Of the 144 patients, 66% were male with a mean age of 60 (±12) years, and 40% were Hispanic and 25% How to cite this article: Cravedi P, Mothi SS, Azzi Y, et al; for the TANGO study group. COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium.
Post-COVID-19 complications in kidney transplant recipients
Russian Journal of Infection and Immunity
Background. Although most people recover from acute COVID-19 within a few weeks, some have long-lasting clinical problems. The prevalence of these prolonged complications in kidney transplant (KT) recipients has not been determined. Materials and methods. Six months following of 148 patients with post-COVID-19 syndrome admitted to three centers in Iran (Tehran, Shiraz and Babol) that underwent KT were included in this study. Also, one-hundred COVID-19 patients without KT were included as the control group. The demographic data, medications, and disease course were recorded. The baseline and demographic characteristics were analyzed using the Chi-square test. Moreover, students t-test were utilized to compare case and control groups. Results. The total number of patients was 248, of which 148 were in the case groups. Hospitalization associated with COVID-19 was for all patients; besides, there were 18 patients in control and 24 case groups admitted to an intensive care unit (ICU). Th...
Cureus
Purpose: Kidney transplant recipients (KTRs) are at an increased risk of severe disease and death caused by coronavirus disease 2019 (COVID-19) infection. There is a paucity of information on the evolution of graft function among hospitalized KTRs who overcome the infection. Methods: The study included adult KTRs at a single transplant institute who were diagnosed with COVID-19 and needed hospitalization between March 15, 2020, and January 15, 2021. We analyzed patient demographics, comorbid risk factors, and inpatient clinical courses for patients who were able to recover from the infection. Kidney function was analyzed pre-infection, during initial hospitalization, and up to 12 months post-infection. Results: We identified 48 KTRs who were diagnosed with COVID-19 infection during the study period. Eighteen KTRs among these needed hospitalization for symptoms of fever and respiratory distress. Four patients died of COVID-19 infection-related complications and were excluded from the study. The 14 remaining patients in the study were predominantly of the Black race (85.7%), with a median time since transplant of four years. Of the patients, 64.3% developed acute kidney injury (AKI), with an average peak serum creatinine (sCr) of 2.6 mg/dl and a glomerular filtration rate (GFR) of 35. The mean sCr and GFR of the group were 2 mg/dl and 44 at baseline (prior to infection). This represented an increase in their sCr and GFR of 34% and 29%, respectively. The median follow-up post-infection was 14.5 months. sCr and GFR were 1.87 mg/dl and 47 at three to six months, and 1.89 mg/dl and 48 at nine to 12 months post-infection. New onset proteinuria was noted in five out of 14 patients (36%), with complete resolution of the same in all at three to six months follow-up. Of patients with AKI, 78% had complete recovery at three to six months follow-up. The mean baseline sCr and GFR of patients who had incomplete recovery was 2.35 and 31.5 with pre-existing proteinuria. Of our entire cohort, there was only one patient who experienced graft loss. This patient had a baseline sCr and GFR of 3.8 mg/dl and 22, existing proteinuria on urinalysis, and a history of biopsy-proven rejection. Conclusion: AKI is common among KTRs who are hospitalized with COVID-19 infection. Most of these recovered, although we noted that patients with baseline lower kidney function and existing proteinuria had a lower recovery rate.
A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States
Cureus
SARS-CoV-2, responsible for the COVID-19 pandemic, is a highly infectious virus that quickly became and continues to be a public health emergency, given the severe international implications. Immunocompromised patients, such as those undergoing kidney transplantation, are at an increased risk for severe illness from COVID-19 and require hospitalization for more aggressive treatment to ensure survival. COVID-19 has been infecting kidney transplant recipients (KTRs), affecting their treatment protocols, and threatening their survival. The objective of this scoping review was to summarize the published literature regarding the impact of COVID-19 on KTRs in the United States in terms of prevention, various treatment protocols, COVID-19 vaccination, and risk factors. The databases such as PubMed, MEDLINE/Ebsco, and Embase were used to search for peer-reviewed literature. The search was restricted to articles that were published on KTRs in the United States from January 1, 2019, to March 2022. The initial search yielded 1,023 articles after removing duplicates, leading to a final selection of 16 articles after screening with inclusion and exclusion criteria. Four domains emerged from the review: (1) impacts of COVID-19 on performing kidney transplants, (2) impacts of COVID-19 vaccinations on KTRs, (3) outcomes of treatment regiments for KTRs with COVID-19, and (4) risk factors associated with an increased mortality rate of COVID-19 in KTRs. Waitlisted patients for kidney transplants had a higher risk of mortality compared to nontransplant patients. COVID-19 vaccinations in KTRs are found to be safe, and the immune response can be improved by placing patients on a low dose of mycophenolate before vaccination. Withdrawal of immunosuppressants showed a mortality rate of 20% without increasing the rate of acute kidney injury (AKI). There is evidence to support that kidney transplantation with the accompanying immunosuppressant regimen can provide KTRs with better COVID-19 infection outcomes compared to waitlisted patients. Hospitalization, graft dysfunction, AKI, and respiratory failure were the most common risk factors that increased the risk of mortality in COVID-19-positive KTRs. Withdrawing KTRs from immunosuppressive drugs increased the mortality rate. Further studies are needed to investigate the effects of specific drugs and dosages on the severity and mortality rate of COVID-19 in KTRs.
Kidney transplantation and COVID-19 renal and patient prognosis
Ndt Plus, 2021
Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.