ABSTRACT
Purpose: Acute kidney injury (AKI) occurs in more than half of kidney transplant recipients (KTRs) with COVID-19. The longitudinal trajectory of kidney function is unclear. To study this, we compare mortality outcomes and long-term allograft function as measured by the change in serum creatinine (SCR) after hospital discharge between kidney transplant patients with SARS CoV-2 who experienced in-hospital AKI with who did not have AKI. Method(s): In this retrospective, multi-center study, we identified 149 KTRs who tested positive for SARS-CoV-2 between March 1st, 2020 and March 31st, 2021. Data from electronic medical records were retrieved and compared between KTRs without AKI and KTRs with AKI who were hospitalized with COVID-19. Creatinine was trended at 0,1,3,6, and 12 months. Result(s): A total of 149 COVID-19 infected KTRs were hospitalized. Of them, 102 (69%) had AKI with 45 (44.1%) in Stage 1, 9 (8.8%) in Stage 2 and 41 (40.2%) in Stage 3. Thirty-three patients died and 97% of them was in AKI group. Patients in AKI group had median survival time of 1.18 months, compared to more than 8 months in non-AKI group (p=0.002), Figure 1. Regression analysis for Intercept and slope were estimated by AKI groups, showing mild improvement in mean SCR over the 1 year at 2.2 mg/dL from peak SCR of 3.6 mg/dL, lowest eGFR 23.9 (SD 14.39) but didn't reach pre-AKI baseline in patients with AKI (1.8mg/dL), Figure 2. Conclusion(s): Patients in AKI group had higher mortality most of which was in the early period. There was mild improvement in creatinine over the following 12 months in AKI group but SCR didn't return to baseline. There with no significant change in slope of creatinine for non-AKI COVID patients.
ABSTRACT
Background: Solid organ transplant (SOT) recipients are considered to be 'vulnerable' to COVID-19 infection due to immunosuppression To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with non-SOT COVID-19 patients We characterized COVID-19 illness and clinical course among SOT recipients and compared the COVID-19 outcomes between SOT recipients and matched non-SOT patients Methods: In this case-control study, we compared the outcomes of COVID-19 between SOT recipients (cases: N=41) and their matched non-SOT (controls: N=121) patients from our center between 3/10/20 and 5/15/20 SOT recipients with COVID-19 were matched with up to three non-SOT COVID-19 controls on age (±5years), race, and admission status Patients were followed up until death or June 10, 2020 The primary outcome was death and secondary outcomes were severe diseasedefined as transfer to the intensive care unit and requiring at least humidified high flow oxygen), intubation and renal replacement therapy (RRT) use Results: The SOT recipients had the following transplants: 9 heart, 3 lung, 16 kidney, 8 liver and 5 dual organ (2 kidney-pancreas,1 heart-kidney, 1 liver-kidney, 1 kidney after liver) with a median age of 60 years (54-69), 80% male, 67% Black, 92% hypertension, 51% diabetes and 80% chronic kidney disease (CKD) Median time from transplant to COVID-19 was 9 years (5-16) Fortyfour percent of SOT COVID-19 had severe disease (61% renal replacement therapy [RRT], 61% intubation and 11% ECMO) The overall (14 6% vs 11 4%, P=NS) and severe disease (33% vs 29%;p=NS) case fatality rates were similar in SOT and non-SOT with COVID-19 Organ type did not predict the severe disease or death in SOT-recipients Risk of death was similar between SOT and non-SOT matched COVID-19 patients (HR=0 84[0 32, 2 20]) after adjusting for disease severity RRT use was higher in SOT recipients than matched non-SOT with COVID-19 (adjusted OR=5 32 [1 26, 22 42]) after adjusting for baseline CKD Tocilizumab use was higher in SOT than non-SOT COVID-19 patients (27% vs 9%, P=0 01) Hydroxychloroquine (HCQ) use for COVID-19 was similar (28% vs 29%;p=0 89) in both the groups Among SOT recipients, those treated with HCQ for COVID-19 had a ten-fold higher hazard of death compared to those who did not receive HCQ (HR=10 62[1 24, 91 09]) (Figure 1) This effect was not seen in non-SOT matched controls with COVID-19 Conclusion: Blacks and Males SOT recipients affected disproportionately with COVID-19 Black constitute one-tenth of all SOT in our center yet they represented two-thirds of COVID-19 cases Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny(Figure Presented).