COVID-19 AND KIDNEY TRANSPLANT RECIPIENTS: IMMUNOSUPPRESSION MANAGEMENT AND OUTCOMES

ABSTRACT

The COVID-19 pandemic raises important questions about immunosuppression management and outcomes in kidney transplant recipients. Kidney transplant recipients with positive SARS-CoV2 PCR seen in outpatient clinics or hospitalized at University and Parkland Hospitals from 3/1-10/1/20 were followed for 90 days. Univariate and multivariate backward selection logistic regression was used to identify risk factors for a composite event of AKI, ICU admission, or death. Non-parametric methods compared biomarkers based on changes in immunosuppressive drugs. Of 59 patients, mean age (SD) was 51 (14) years, 35 (59%) were male, 13 (22%) black and 36 (61%) Hispanic. 29 (50%) had a baseline eGFR <60 mL/min/1.73 m2, 52 (88%) had hypertension and 33 (56%) diabetes. 55 (93%) were on calcineurin inhibitors (CNI) and 49 (83%) on an antimetabolite at baseline. 6 (10%) were treated for acute rejection in the 12 months prior. Initial ferritin level was higher in those who had CNI dose decreased or discontinued vs. those with CNI unchanged, median (IQR) 1271 (839-1932) vs 283 (124-569) ng/mL, p=0.0002. Patients who stopped CNI showed significantly higher peak hsCRP values than those maintained on the same dose, median (IQR) 344 (145-374) vs 41 (22-116) vs mg/L, p=0.03. There were 31 composite events, 43 hospitalizations, 13 ICU admissions, and 12 deaths. Of 52 patients with creatinine values, 29 (56%) had AKI, of which 10 (35%) required RRT. 13 (46%) had recovery of AKI at 90 days, defined as serum creatinine within 10% of baseline. Factors associated with the composite are shown (table). eGFR< 60 and peak hsCRP remained in the multivariable model associated with the composite, with area under the curve =0.89. 1OR per 1 unit increase X 109/L1 Over half of kidney transplant patients with COVID-19 had AKI and 73% required hospitalization. Elevated markers of inflammation were associated with changes in CNI regimen. An eGFR<60 and higher peak hsCRP were associated with increased risk of death, ICU admission, or AKI.