COVID-19 in Hospitalized Kidney Transplant Recipients: Clinical Course, Prognostic Factors and Differences Between First and Second Waves
Nephrology, Hospital Gregorio Marañón, Madrid, Spain
Meeting: 2021 American Transplant Congress
Abstract number: 748
Keywords: Infection, Kidney transplantation, Pneumonia, Sirolimus (SLR)
Topic: Clinical Science » Infectious Disease » All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis)
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: The aim was to describe the clinical course and management of SARS-CoV-2 infection in kidney transplant recipients (KTR) hospitalized with COVID-19, identify risk factors for severity, and analyze the differences between first (March-June) and second (Aug-Nov,2020) waves.
*Methods: Retrospective, single-center study in 48 KTR (24 in each wave) admitted with COVID-19. Baseline features, immunosuppression, clinical findings, laboratory and radiological data and therapies were analyzed to identify risk factors for “severe COVID” (requiring oxygen reservoir bag, high-flow nasal cannula and/or invasive mechanical ventilation).
*Results: Age was 58.9 ± 13 years, 75% were male, 60.5 (24 – 143) months after KT. 20.8% were nosocomial and there were 2 “reinfections”. Main symptoms were fever (71%), dyspnea (56%), cough (48%) and diarrhea (40%). 87.5% developed pneumonia, 77% needed supplemental oxygen, 14.6% were admitted to ICU (12.5% for invasive ventilation) and 8.3% died.
Table 1 shows main differences in KTR with severe COVID. In multivariable regression analysis with different models including age, sex, blood group, comorbidity, immunosuppression, RAS blockers and:1) SatO2, platelets and LDH at admission: only everolimus (adjusted OR: 204, p 0.047) as independent predictor for severity.2)clinical course: everolimus (adjusted OR: 61.7, p 0.021) and poor clinical course at one week (adjusted OR: 546, p 0.015) were associated with severe COVID.In the second wave the patients consulted earlier (p 0.029) and SARS-CoV-2 infection was less severe (p 0.001) with less use of reservoir (p 0.008), lower inflammatory markers at admission [CRP (p 0.010), IL-6 (p 0.048) and ferritin (p 0.045)], and more mild cases without oxygen need (p 0.048). There were fewer pneumonia at admission and 48h after, but no differences at one-week, and more patients were treated with steroids (79% vs 42%, p 0.017).
*Conclusions: Everolimus could represent a risk factor for severity in KTR hospitalized with COVID-19. In the second wave there was a wider use of steroids, though SARS-CoV-2 infection was less severe.
To cite this abstract in AMA style:
Macías N, Ferrero MRodríguez, Acosta A, Carbayo J, Rojas ÁGonzález, Morales AMuñozde, Prieto AGarcía, Goicoechea M. COVID-19 in Hospitalized Kidney Transplant Recipients: Clinical Course, Prognostic Factors and Differences Between First and Second Waves [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/covid-19-in-hospitalized-kidney-transplant-recipients-clinical-course-prognostic-factors-and-differences-between-first-and-second-waves/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress