Predictors of Severe Covid-19 in Kidney Transplant Recipients in the First and Second Waves: Analysis of the Spanish Registry

M. Crespo¹, A. Mazuecos², I. Pérez-Flores³, F. Moreso⁴, A. Andrés⁵, C. Jimenez⁶, M. Molina⁷, C. Canal⁸, L. Sánchez-Cámara⁹, S. Zárraga¹⁰, M. Ruiz Fuentes¹¹, M. Aladrén¹², E. Melilli¹³, V. López¹⁴, E. Sanchez¹⁵, J. Pascual for Spanish Nephro Society Covid-Registry¹

¹Nephrology, Hospital del Mar, Barcelona, Spain, ²Nephrology, Hospital Puerta del Mar, Cadiz, Spain, ³Nephrology, Hospital Clinico San Carlos, Madrid, Spain, ⁴Nephrology, Hospital Valle Hebrón, Barcelona, Spain, ⁵Nephrology, Hospital 12 Octubre, Madrid, Spain, ⁶Nephrology, Hospital La Paz, Madrid, Spain, ⁷Nephrology, Hospital Germans Trias i Pujol, Barcelona, Spain, ⁸Nephrology, Fundacio Puigvert, Barcelona, Spain, ⁹Nephrology, Hospital Gregorio Marañón, Madrid, Spain, ¹⁰Nephrology, Hospital de Cruces, Bilbao, Spain, ¹¹Nephrology, Hospital Virgen de las Nieves, Granada, Spain, ¹²Nephrology, Hospital Miguel Servet, Zaragoza, Spain, ¹³Nephrology and Kidney Transplantation, Hospital de Bellvitge, Barcelona, Spain, ¹⁴Nephrology, Hospital Regional de Málaga, Malaga, Spain, ¹⁵Nephrology, Hospital de Cabueñes, Gijon, Spain

Meeting: 2021 American Transplant Congress

Abstract number: 60

Keywords: Age factors, Kidney transplantation, Mortality, Pneumonia

Topic: Clinical Science » Infectious Disease » Kidney Infectious Non-Polyoma & Non-Viral Hepatitis

Session Information

Session Name: COVID-19 in Kidney Recipients

Session Type: Rapid Fire Oral Abstract

Date: Saturday, June 5, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:05pm-6:10pm

Location: Virtual

*Purpose: To better know the impact and characteristics of Covid-19 in renal patients, the Spanish Society of Nephrology set up a voluntary registry in March, 2020

*Methods: Retrospective observational study of KT recipients included in the Spanish Covid-19 Registry (1^st March to 14^th November, 2020). We applied Cox multivariate analysis to identify risk factors for mortality and Kaplan-Meier and log rank survival analysis.

*Results: 1080 KT with Covid-19 were registered, having 937 (86.1%) their outcome reported (cure or death). Most were men (63.2%), mean age 60 years infected a median of 72 months postransplantation. Death occurred in 204 patients. Multivariate analysis found age, neumonia and KT within the last 6 months before Covid-19 were risk factors for mortality and gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups: age<65 years&postransplant time> 6mo (n=526), age<65&time<6mo (n=49), age>65&time >6mo (n=325) and age>65&time<6mo (n=31)($$graphic). Of 1080 cases, 605 correspond to the first wave (1^stW until June2020) and 475 to the second wave (2^ndW). In the 2^ndW, KT were younger (56.4 vs 61.1yr; p=.000), 15.8% were asymptomatic (p=.000) and presented less pneumonia (50.3% vs. 78%; p=.000). Fever, lymphopenia and respiratory symptoms were less frequent but gastrointestinal symptoms similar (30.9% vs. 34.2%; p=.256). Treatment has changed, with more use of remdesivir (p=.000) and steroids (p=.018), no use of ritonavir/lopinavir, hidroxycloroquine andazitromycin (p=.000), and no treatment in (37.1% vs 6.3% in 1^stW, p=.000). Hospitalization decreased (89.2% vs. 63.2%; p=.000) but more KT were admitted to critical care units (14.5% vs 20%; p=.058). We found lower mortality (overall 26.4% vs 14.8%; p=.000, hospitalized 29% vs 23%; p=.088). Multivariate analysis of the 2^ndW shows again that age, pneumonia and recent transplant (< 6 months) are mortality risk factors.

*Conclusions: Over a thousand KT have suffered Covid-19 in Spain with a high mortality rate in the first and second waves, mainly related with age, pneumonia and recent transplantation. The interaction between age and time after transplant has to be considered when selecting recipients in the Covid-19 pandemic.

To cite this abstract in AMA style:

Crespo M, Mazuecos A, Pérez-Flores I, Moreso F, Andrés A, Jimenez C, Molina M, Canal C, Sánchez-Cámara L, Zárraga S, Fuentes MRuiz, Aladrén M, Melilli E, López V, Sanchez E. Predictors of Severe Covid-19 in Kidney Transplant Recipients in the First and Second Waves: Analysis of the Spanish Registry [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/predictors-of-severe-covid-19-in-kidney-transplant-recipients-in-the-first-and-second-waves-analysis-of-the-spanish-registry/. Accessed November 21, 2024.

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