COVID-19 outcomes in renal transplant patients-a single-center case series

ABSTRACT

Purpose of Study Initially detected in Wuhan, China, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is responsible for coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. Immunocompromised patients, including kidney transplant recipients, are at increased risk of morbidity and mortality but granular data from transplant centers such as ours serving a majority- minority and rural population are still scant. We aim to describe the impact of COVID-19 in our unique cohort of transplant patients. Methods Used During the pandemic, all transplant patients followed up at our center with reported COVID-19 were included in a registry. A case series of 136 patients drawn from this registry were included in this preliminary analysis spanning the period of March 2020 to March 2021. Statistical analysis was performed with R. Summary of Results The characteristics of our patients were 54% male, 53% Black, 40% White, Median age 53 years, Median BMI 31, 47% were diabetic, 96% had hypertension, 16% had coronary artery disease. Median time after transplantation was 6.2 years (range 4 days to 37 years), 61% had thymoglobulin induction and almost uniformly were on tacrolimus, mycophenolate and prednisone. Baseline median creatinine 1.3 mg/dl and urine protein to creatinine ratio 0.18 g/g. The most commonly reported symptoms were fever (51%) dyspnea (48%), fatigue (46%) and myalgia (31%). 49% were hospitalized of whom half required ICU care. 82% of ICU patients were on ventilator support. 45% of patients had AKI, 7% required dialysis. 35% of patients required oxygen. There were 6 graft losses (4%) and 26 deaths (19%). Immunosuppression was reduced in most patients with antimetabolite reduction in 54%, and calcineurin inhibitor reduction in 44%. Treatments included dexamethasone (31%), and remdesivir (21%, convalescent plasma (6%), and monoclonal antibodies (4%). Creatinine and proteinuria post-COVID remained stable (1.4 mg/dl and 0.17 g/g respectively). 118 patients were followed up in clinic post-COVID and of these 15% reported continued severe COVID symptoms. On univariate analysis, age, race, gender, ABO blood type, diabetes status, cardiovascular disease, induction, time from transplant, baseline creatinine, proteinuria, baseline immunosuppression regimen, ACEi or ARB use, and reported symptoms (except for dyspnea) were not associated with risk of death. On multivariate analysis, ICU admission and need for dialysis were strongly predictive of death. Conclusions Despite serving a large rural population with a high burden of comorbidities, patient outcomes following COVID infection from our study are similar to other singlecenter and multi-center reports. As expected, the mortality rate in our cohort is much higher than the general population with high rates of hospitalization and need for ICU care. Aside from a significant minority, most patients recovered well and had stable renal allograft function. Our study is limited by its retrospective nature and risk of reporting bias.