ABSTRACT
Purpose: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19, has emerged as a viral pandemic and brought unprecedented challenges worldwide on health care systems, including our transplantation community. Data on the clinical characteristics and outcomes of patients with COVID-19 infection in kidney transplant recipients (KTRs) remain uncertain. Here we describe the clinical characteristics and outcomes of KTRs in the Southeastern US who contracted COVID-19. Methods: A retrospective review of KTRs who tested positive for COVID-19 from March 15th, 2020 until November 25th, 2020 and followed at our institution were included. Data including patient demographics, history, laboratory results, radiological findings, and clinical outcomes was collected from the electronic medical record. Summary statistics using Kruskal-Wallis and Chi-square tests were performed. Multivariable logistic regression was used to identify risk factors for inpatient admission. Results: There were 104 patients who tested positive for COVID-19 either at our institution or a referring hospital (Table 1). Fifty-six (54%) patients required hospitalization. Labs on admission were: mean WBC 6.6±2.8 (x10-3/mcL), serum creatinine 2.3±1.7 (mg/dL), CRP 96±84 (mg/L), ferritin 1093±1052 (ng/mL), procalcitonin 0.62±1.0 (ng/mL), lactate 1.2±0.4 (mEq/L). Admitted patients were treated with dexamethasone (54%) and remdesivir (23%), and the anti-metabolite was held in 71%. Nineteen patients required ICU stay, 13 were intubated, 25 developed AKI and 12 died related to COVID-19 (11%). Mean length of inpatient stay was 11±13 days. After adjustment for age, DM and CAD status, the risk of admission due to COVID-19 was higher in those presenting with fever (OR 3.12, 95% CI 1.23-7.92, P-Value 0.017), and SOB (OR 7.64,95% CI 1.89-30.9, P-Value 0.004) (Table 2). Conclusions: The majority of KTRs with COVID-19 in our cohort required hospital admission. The mortality rate was 11% which is at the lower end of the spectrum of what has been previously reported. Despite this, COVID-19 remains a significant risk for our kidney transplant recipients with a high rate of hospital admission.
ABSTRACT
Purpose: In 2018, the OPTN board approved changes to kidney-pancreas (KP) waiting time criteria. KP candidates accrued waiting time if they were (1) on insulin and had a C-peptide <=2ng/mL or (2) on insulin and had a C-peptide >=2ng/ mL and had a BMI <=30kg/m∧2 which was the maximum allowable BMI. Since 7/11/2019 candidates must be on insulin, registered for a KP, and meeting kidney waiting time criteria. Methods: Registrations added to the waitlist and transplants between 7/11/2018- 7/10/2019 (pre-implementation) or 7/11/2019-7/10/2020 (post-implementation) were compared. Data originated from OPTN waitlist, Transplant Candidate Registration forms and Transplant Recipient Registration forms as of 10/16/2020. Results: 1,389 registrations were added to KP and 42,229 to kidney alone (KI) waitlists (pre-implementation);854 KP and 19,196 KI transplants performed. 1,401 registrations were added to KP and 19,493 KI waitlists (post-implementation);814 KP and 19,493 KI transplants performed. The proportion of type 2 diabetes (T2DM) KP candidates and recipients increased from 23.29% to 27.45% and 21.41% to 27%, respectively (Table 1). Candidate mean BMI increased from 25.7 to 26.3. KP recipients with T2DM and C-peptide >2ng/mL had higher median BMIs than those with lower C-peptide. KP post-transplant outcomes stratified by ethnicity, BMI, and diabetes status remained similar. The proportion of KI candidates and recipients remained roughly unchanged. Pediatric KI organ offers increased (527 to 592 offers per 100 active patient-years) but transplants remained unchanged. Conclusions: Changes in KP waiting time criteria did not adversely affect KI or pediatric KI candidates. Removing the BMI cutoff for obese patients with T2DM resulted in higher BMI KP transplants with equivalent post-transplant outcomes compared to lower BMI recipients. Although total KP transplants were slightly less in the post-implementation period, registrations were more and the transplant volumes were likely adversely affected by the COVID-19 pandemic.