The Impact of Maintenance Immunosuppressive Regimen on COVID-19 Outcomes Among Kidney Transplant Patients

T. V. Sandes-Freitas¹, L. Modelli de Andrade², L. Requião-Moura³, J. Medina-Pestana³, H. Tedesco-Silva³, A. on behalf of Covid-19 KT Brazil Study Group¹

¹Universidade Federal do Ceará / Unidade Pesquisa Clínica CH-UFC/EBSERH, Fortaleza, Brazil, ²Universidade Estadual Paulista - UNESP, Botucatu, Brazil, ³Universidade Federal de São Paulo / Hospital do Rim, São Paulo, Brazil

Meeting: 2022 American Transplant Congress

Abstract number: 684

Keywords: COVID-19, Immunosuppression, Kidney transplantation

Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: All Infections (Excluding Kidney & Viral Hepatitis) I

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: Compared to azathioprine (AZA), mycophenolate (MPA) is implicated in an increased risk of several viral infections. Contrariwise, mTOR inhibitors (mTORi) are protective. Therefore, the study proposal is to evaluate the Covid-19 outcomes among kidney transplants (KT) patients under different maintenance immunosuppressive regimens.

*Methods: We analyzed 90-day outcomes after Covid-19 infection using national-wide Brazilian cohort data. RT-PCR positive patients tested between Mar/20 and Apr/21 (before immunization) were included. Patients using calcineurin-inhibitors (CNI)-free regimens were excluded.

*Results: 1,833 patients from 44 centers were analyzed, divided into three groups: CNI-AZA (n=389), CNI-MPA (n=1,258), and CNI-mTORi (n=186). Except for donor source, time after KT, and diabetes, demographics were similar among groups (Table1). The main outcomes are shown in Table 1. Considering CNI-AZA as the reference group, center-adjusted multivariable Cox regression showed that the CNI-MPA group was associated with higher 30-day fatality (HR 1.65, 95% CI 1.17-2.33, p=0.004), effected also demonstrated in 90-day fatality (HR 1.43, 95%CI 1.06-1.93, p=0.020). CNI-mTORi was neutral for the 30-day fatality (HR 0.75, 95%CI 0.43-1.29, p=0.296), but protective for the 90-day (HR 0.56, 95%CI 0.34-0.94, p=0.027).

*Conclusions: This data suggests that maintenance immunosuppressive drugs impact Covid-19 outcomes in kidney transplant patients. While MPA is associated with poor prognosis, mTORi seems to be protective.

Table 1. Demographics and outcomes of KT patients with Covid-19 infection
	CNI-AZA	CNI-MPA	CNI-mTORi	p-value
Deceased donor KT	48%	74%	65%	<0.001
Time after KT-years	7.5 (3.8 – 12.6)	5.0 (1.9 – 9.4)	3.4 (1.2 – 5.7)	<0.001
Diabetes	29%	34%	45%	<0.001
Hospitalization	46%	67%	61%	<0.001
Mechanical Ventilation	18%	27%	13%	<0.001
30-day fatality rate	12%	20%	11%	<0.001
90-day fatality rate	16%	25%	12%	<0.001

To cite this abstract in AMA style:

Sandes-Freitas TV, Andrade LModellide, Requião-Moura L, Medina-Pestana J, Tedesco-Silva H. The Impact of Maintenance Immunosuppressive Regimen on COVID-19 Outcomes Among Kidney Transplant Patients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-maintenance-immunosuppressive-regimen-on-covid-19-outcomes-among-kidney-transplant-patients/. Accessed June 7, 2025.

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