ABSTRACT
Background: COVID-19 infection is associated with worse outcomes in kidney transplant recipients (KTRs). Despite wide availability of safe and effective vaccines, transplant recipients are disproportionately affected. We aim to investigate our center's experience with COVID-19 hospitalization in KTRs and measure their clinical outcomes. Method(s): In this retrospective observational cohort study, we identified KTRs who developed COVID-19 infection between March 2020 and January 2022 within our integrated health network. Through chart review, patient characteristics and outcomes were collected. Result(s): Among 186 patients who tested positive for COVID-19, 114 (61%) required hospitalization out of which 53 received at least one dose of vaccine and 61 were unvaccinated. Among the unvaccinated, 26 (43%) patients were admitted prior to January 2021 when vaccines were not yet widely available. Vaccination rate among patients admitted after January 2021 was 53/88 (60%). Baseline characterisitcs between vaccinated and unvaccinated patients were similar. There were 24 deaths during admission and another 7 deaths within 90 days, for a total of 31/114 (27%). There was a trend towards lower mortality in vaccinated patients (10/53 (19%) vs. 21/61 (34%), p=0.06). The need for dialysis was significantly lower in vaccinated patients (9/53 (17%) vs. 21/61 (34%), p=0.03) (Table). Conclusion(s): COVID-19 infection is associated with higher mortality in KTRs with a mitigating effect from vaccination. Decreased dialysis requirement in vaccinated but hospitalized KTRs with COVID-19 infection likely reflects less severe infection, indicating that vaccination confers allograft protection. Every effort should be made to encourage and educate KTRs regarding COVID-19 vaccination including booster doses in order to reduce morbidity and mortality. (Figure Presented).
ABSTRACT
Background: Mortality rates for COVID-19 infection vary widely. Immunocompromised patients in general have worse outcomes. We aimed to evaluate kidney transplant recipients (KTRs) who were admitted for COVID-19 infection and investigate patient specific factors or comorbidities that may have influenced mortality rates. Method(s): In this retrospective study, we identified KTRs who developed COVID-19 infection between March 2020 and January 2022 within our integrated health network. Through chart review, patient characteristics were collected and stratified by 90-day mortality. Result(s): Out of 114 KTRs hospitalized with COVID-19 infection, 24 (21.0%) died during admission, and another 7 died within 90 days of admission bringing total 90-day mortality to 31/114 (27.2%). Among the114 hospitalized patients, 53 (46.5%) had received at least one prior COVID-19 vaccine dose including 35 who received two doses and 9 who received >=3 doses. KTRs who survived following COVID-19 hospitalizations were significantly younger and were more likely to be vaccinated (Table). Conclusion(s): Approximately 1 out of 4 KTRs admitted for COVID-19 infection died within 90-days. Older age was a mortality risk factor and vaccination conferred protection against mortality in these immunocompromised patients. Our study highlights the importance of vaccination in these patients. Relatively small sample size likely limited identification of other potential risk factors for mortality in our analysis.
ABSTRACT
Background: Studies have shown suboptimal immunological response to COVID-19 vaccination in kidney transplant recipients (KTRs). We aimed to describe specific characteristics of vaccinated KTRs who required hospitalization for COVID-19 infection. Method(s): In this descriptive study utilizing chart review, we identified KTRs who were hospitalized for COVID-19 infection between March 2020 and January 2022 within our integrated health network. Demographic characteristics were identified for KTRs who received >=2 COVID-19 vaccine doses prior to hospitalization. Result(s): Among 114 KTRs admitted to the hospital with COVID-19 infection, 44 (39%) had received 2 or more vaccine doses prior to hospitalization including 35 patients who received 2 vaccines and 9 who received >2 vaccines. Vaccinated patients requiring hospitalization were generally older with male predominance. Prevalent comorbidities included overweight/obesity, hypertension, and diabetes. Among these patients, 18% required dialysis and 90-day mortality was 20% (Table). Conclusion(s): Despite receiving at least 2 doses of preventative vaccination, many KTRs developed COVID-19 infection requiring hospitalization. Our findings are consistent with studies showing reduced antibody and cell mediated response to vaccination in KTRs. Every effort should be made to educate and encourage this vulnerable population about measures to prevent infection, especially vaccination with subsequent booster doses.
ABSTRACT
Background: Timing of kidney replacement therapy (KRT) and transplant referral in chronic kidney disease (CKD) G4 and G5 is a difficult topic. The COVID-19 pandemic has disrupted nearly all aspects of healthcare, including the process of KRT plan. This study examined if the addition of a Transition Coordinator (TC) improved KRT transition plan despite the pandemic. Methods: Retrospective descriptive study examining patients at single academic practice with eGFR <20 that completed CKD educational program (CKDEP). Control Group: 5/1/19-1/31/20 with in-person CKDEP, no TC. Intervention Group (IG): 5/1/20-1/31/21 with virtual or in-person CKDEP with addition of TC. TC called patient monthly to assess barriers to KRT planning, assist with scheduling, and communicate with Nephrologist. Success was defined as having a KRT plan. Failure was defined as either urgent start dialysis via dialysis catheter (DC) or patients without KRT plan. Results: CG had n=15 while IG had n=47. Both groups were evenly distributed with age, average eGFR (15). The CG had slightly higher rates of urgent starts and patients without KRT plan compared to IG (Table 1). Patients were referred for Vascular access +/-Transplant 20% (3) in CG and 23% in IG. PD +/-Transplant was chosen in 6.7% (1) of CG and 36% (17) of IG. Success and Failure rates were similar in both groups (Table 2). Conclusions: Despite the pandemic, there was no overall change in rate of failure (urgent start or lack of KRT plan), however, individual decreases in these groups were noted. This could indicate that TC may improve outcomes when the pandemic is controlled. Increased interest in PD was noted which could indicate greater understanding via follow up provided by TC. (Table Presented) .