Association Between Maintenance Immunosuppressive Regimens And Covid-19 Mortality In Kidney Transplant Recipients
1Nephrology, Nice University Hospital, Nice, France, 2Institute of Molecular and Cellular Pharmacology, CNRS, Valbonne, France, 3Nephrology, Necker University Hospital, APHP, Paris, France, 4Nephrology, Bordeaux Pellegrin University Hospital, Bordeaux, France, 5Nephrology, Lille University Hospital, Lille, France, 6Nephrology, Edouard Herriot Hospital, Hospices civils de Lyon, Lyon, France, 7Nephrology, Nantes University Hospital, Nantes, France, 8Nephrology, Strasbourg University Hospital, Strasbourg, France
Meeting: 2022 American Transplant Congress
Abstract number: 9026
Keywords: COVID-19, Immunosuppression, Kidney transplantation, Mortality
Topic: Basic & Clinical Science » Basic & Clinical Science » 73 - COVID-19
Session Information
Session Name: Late Breaking: Basic / Translational
Session Type: Rapid Fire Oral Abstract
Date: Monday, June 6, 2022
Session Time: 3:30pm-5:00pm
Presentation Time: 4:10pm-4:20pm
Location: Hynes Room 313
*Purpose: Kidney transplant recipients (KTR) are at increased risk of mortality from COVID-19. We conducted a cohort study among KTR from the French Solid Organ Transplant COVID-19 (SOT COVID) registry to investigate the association between maintenance immunosuppressive drugs and 60-day mortality in KTR with COVID-19.
*Methods: Data from all KTR with COVID-19 included in SOT COVID 02/28/2020 and 12/30/2020 were retrieved. Among them, 116 were excluded because of missing data on immunosuppressive therapy. We evaluated associations between immunosuppressive drugs and death ≤60 days of 1st symptoms using logistic regression, with all baseline characteristics considered to influence outcome or immunosuppressive regimen. Benjamini-Hochberg correction was used for controlling false positive rate; 40 multiple imputations were performed. Adjusted p-value <0.05 was considered statistically significant.
*Results: There were 1,451 KTR included. Median age was 58 years, 963 (66.4%) were men. Most frequent comorbidities were hypertension (n=1188, 81.9%), diabetes (501, 34.5%), cardiovascular disease (428, 29.5%). Median time since transplant was 71 months. Maintenance immunosuppression regimen included calcineurin inhibitors (1295, 89.2%), antimetabolites (1205, 83%), corticosteroids (1094, 75.4%), Mammalian Target of Rapamycin inhibitors (144, 9.9%) and belatacept (58, 4.0%). Among 1,451 KTR, 201 (13.9%) died ≤60 days. Older age and baseline creatininemia were associated with mortality (OR: 1.09 [1.07-1.11]; 1.01 [1.005-1.009], p<0.001). Corticosteroid-free regimens were associated with a significantly lower risk of death (OR: 0.48 [0.31;0.76], p=0.011). All other variables yielded non-significant adjusted p-values.
*Conclusions: Corticosteroid-free regimens were associated with a lower risk of death in KTR with COVID-19. While a short course of high-dose corticosteroids is beneficial in severely ill COVID-19 patients, prolonged maintenance corticosteroids expose to chronic immune disorders that may predispose KTR to severe forms of COVID-19.
To cite this abstract in AMA style:
Gérard AO, Barbosa S, Anglicheau D, Couzi L, Hazzan M, Thaunat O, Blancho G, Caillard S, Sicard A. Association Between Maintenance Immunosuppressive Regimens And Covid-19 Mortality In Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/association-between-maintenance-immunosuppressive-regimens-and-covid-19-mortality-in-kidney-transplant-recipients/. Accessed May 17, 2025.« Back to 2022 American Transplant Congress