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Clinical Course and Outcomes of COVID-19 in Kidney Transplant Recipients
Divya Bajpai1, Satarupa Deb1, Sreyashi Bose1
1Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India.
Insights
Coronavirus disease 2019 (COVID-19) poses significant risks to kidney transplant recipients (KTR), leading to high rates of acute kidney injury (AKI) and mortality. This study identified key risk factors for severe outcomes in KTR with COVID-19.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Kidney transplant recipients (KTR) face elevated risks of severe outcomes and mortality from coronavirus disease 2019 (COVID-19).
- Understanding the clinical characteristics and risk factors for COVID-19 in KTR is crucial for improving patient management and outcomes.
Purpose of the Study:
- To explore the clinical characteristics, outcomes, and immunological responses of COVID-19 in kidney transplant recipients.
- To determine the risk factors associated with mortality and severe COVID-19 disease in this vulnerable population.
Main Methods:
- A review of clinical profiles, outcomes, and immunological responses was conducted for KTR admitted with COVID-19.
- Risk factors for mortality and severe COVID-19 were identified through univariate analysis.
Main Results:
- Of 60 KTR admitted with COVID-19, 56.4% experienced severe disease, 83% developed acute kidney injury (AKI), and 13% died.
- Mortality was linked to baseline graft dysfunction, hypoxia, anemia, elevated transaminases and C-reactive protein, diffuse lung involvement, hypotension, and KDIGO stage 3 AKI.
- Immunological responses showed 66.6% developed IgM and 82.3% developed IgG antibodies by last follow-up.
Conclusions:
- COVID-19 infection in kidney transplant recipients is characterized by a high incidence of acute kidney injury and significant mortality.
- Identifying risk factors such as graft dysfunction and hypoxia is critical for managing COVID-19 in KTR.
Introduction:
Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR.
Methods:
We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19.
Results:
Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1-5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21-81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies.
Conclusion:
COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality.
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