Clinical characteristics of COVID-19 in kidney transplant recipients and analysis the risk factors for severe/critical infections / 中华器官移植杂志

ABSTRACT

Objective:To explore the clinical characteristics and outcomes of SARS-CoV-2 infection in kidney transplant recipients(KTRs)and examine the risk factors for severe/critical infection.Methods:A retrospective analysis was conducted for 208 adult KTRs diagnosed with SARS-CoV-2 infection between December 15, 2022, and March 15, 2023.They were assigned into two groups of mild/ordinary(n=168)and severe/critical(n=40)according to the severity of SARS-CoV-2 infection.Two groups were compared with regards to general profiles, status of baseline vaccination against COVID-19, transplant history, immunosuppressive regimens, comorbidities and treatment outcomes.For continuous variables, t or Mann-Whitney U test was utilized for comparing the inter-group differences.For categorical variables, chi-square or Fisher's exact test was employed.Bonferroni correction was applied for multiple comparisons when p value was ≤0.05.Logistic regression analysis of univariates and multivariates was conducted for identifying the risk factors for severe/critical infections.Results:The rates of hospitalization, severe illness, ICU admission, mechanical ventilation and mortality among 208 KTRs with COVID-19 were 27.4%(57/208), 19.2%(40/208), 3.4%(7/208), 5.3%(11/208)and 1.9%(4/208)respectively.Among 57 COVID-19 infected individuals, 43.9%(25/57)experienced bone marrow suppression with an incidence of anemia 36.8%(21/57)and thrombocytopenia 22.8%(13/57). The lowest counts of whole blood lymphocyte, CD4 + T lymphocyte and CD8 + T lymphocyte were 390.0(245.0, 615.0), 138.0(78.0, 293.5)and 180.0(94.7, 575.2)cells/μL respectively.The incidence of bacterial, cytomegaloviral, Pneumocystis jirovecii and other fungal infections after COVID-19 infection was 17.8%(37/208), 3.8%(8/208), 2.9%(6/208)and 2.9%(6/208)respectively.The severe/critical group had a higher incidence of other pathogen infections as compared to mild/ordinary group, including bacterial infections[62.5%(25/40)vs 7.1%(12/168), 95% CI: 47.5%~63.3%, P<0.001], cytomegaloviral infections[15.0%(6/40)vs 1.2%(2/168), 95% CI: 8.1%~19.5%, P=0.001], P.jirovecii infections[15%(6/40)vs 0(0/168), 95% CI: 9.4%~20.6%, P<0.001]and other fungal infections of Candida, Cryptococcus, Malassezia and Aspergillus fumigatus[15.0%(6/40)vs 0(0/168), 95% CI: 9.4%~20.6%, P<0.001]. The incidence of acute kidney injury(AKI)after COVID-19 infection was 13.5%(28/208)and severe/critical group had a higher incidence of AKI than mild/ordinary group[52.5%(21/40)vs 4.2%(7/168), 95% CI: 40.3% to 56.3%, P<0.001]. Univariate analysis showed that age( P=0.003), male gender( P=0.002), smoking history( P=0.012), coronary heart disease( P=0.011), diabetes mellitus( P=0.002), chronic renal insufficiency( P=0.001)and pulmonary disease history( P=0.001)were significantly different between severe/critical and mild/ordinary groups.Multivariate regression analysis revealed that comorbid chronic kidney disease( OR=3.34, 95% CI: 1.46-7.64, P=0.004)and a history of lung disease( OR=3.42, 95% CI: 1.49-7.87, P=0.004)were independent risk factors for severe/critical illness.Baseline vaccination rate against COVID-19 was 17.8%(37/208). Completion of baseline vaccination was associated with a lower risk of severe/critical COVID-19 infection( OR=0.28, 95% CI: 0.08-0.98, P=0.047). Conclusions:KTRs with severe/critical COVID-19 infections are more prone to multiple pathogen co-infections and the incidence of kidney function impairment after infection has remained relatively high.Histories of pulmonary and chronic kidney diseases are independent risk factors for severe/critical infections.Completion of baseline vaccination provides protection against severe/critical infections.