Is COVID-19 infection more severe in kidney transplant recipients?

Graft Rejection Male [SDV]Life Sciences [q-bio] MESH: Registries* Aucun MESH: Comorbidity Comorbidity MESH: Risk Factors [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases cardiovascular disease Risk Factors clinical research / practice Immunology and Allergy Pharmacology (medical) MESH: Incidence kidney transplantation / nephrology Registries MESH: Aged MESH: France / epidemiology MESH: Middle Aged MESH: Transplant Recipients / statistics & numerical data* Incidence Middle Aged 3. Good health Intensive Care Units MESH: COVID-19 / epidemiology [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases Female France glomerular filtration rate (GFR) kidney failure / injury Immunosuppressive Agents infection and infectious agents - viral infectious disease 610 MESH: Graft Rejection / prevention & control MESH: Severity of Illness Index MESH: COVID-19 / diagnosis* Humans MESH: SARS-CoV-2 Propensity Score Pandemics Aged Retrospective Studies Immunosuppression Therapy Transplantation MESH: Humans SARS-CoV-2 MESH: Graft Rejection / epidemiology* COVID-19 MESH: Retrospective Studies Kidney Transplantation MESH: Male immunosuppressive regimens MESH: Immunosuppressive Agents / therapeutic use MESH: Pandemics* MESH: Propensity Score* MESH: Immunosuppression / methods MESH: Intensive Care Units MESH: Kidney Transplantation* MESH: Female
DOI: 10.1111/ajt.16424 Publication Date: 2020-12-01T23:44:38Z
ABSTRACT
There are no studies which have compared the risk of severe COVID-19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID-19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single-center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID-19 or mortality. Severe COVID-19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30-day cumulative incidence of severe COVID-19 did not differ between KTR and nontransplant patients; however, 30-day COVID-19-related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C-reactive protein (CRP) were associated with severe COVID-19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID-19-related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID-19-related mortality compared to nontransplant hospitalized patients.
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