Does the Use of High-Dose Corticosteroids in Renal Transplant Recipients during Long-Term Impact Covid-19 Have?

ABSTRACT

BACKGROUND: The long-term outcomes of renal transplant recipients (RTR) affected by SARS-COV2 infection are an unexplored area particularly given the heightened immunosuppression and post-COVID-19 sequelae and increased fungal infections. We aimed to analyze the patient and graft outcomes, infectious and non-infectious sequelae in RTR with COVID-19 over a long-term follow-up of 24 months. AIM OF THE STUDY To analyze the patient and graft outcomes, infectious and non-infectious sequelae in RTR with COVID-19 over a long-term follow-up of 24 months. METHOD(S) This retrospective study included the RTR admitted during the two pandemic waves between March 25, 2020, and July 31, 2021. The survivors were followed for a maximum period of 24 months (till September 2022) and were studied for readmission rates, serious infection requiring hospitalization (SIRH), graft dysfunctions and biopsy-proven acute rejections (BPAR), patient and graft survival. RESULT(S) Of 251 RTRs with SARS-COV2 infection, 104 were treated during the first wave and 147 during the second wave. After an index mortality noted in 38 patients (15.1% - 11.5% in first wave vs 17.5% in second wave, P = 0.23), follow-up data of 213 patients were analyzed. 45 patients were lost to follow-up, and a complete follow-up data was available for 168 patients. A total of 70 patients (41.7%) required readmission with SIRH being the most common indication for readmission (19.6%) followed by rejection (8.9%). Patients who received high dose steroids during the COVID-19 illness had higher SIRH (32.4% vs 16%, p = 0.027). However, graft dysfunctions (13.5% vs 16%, p = 0.70) and the BPAR (8.1%vs9.2%, p = 0.84) were similar in both the groups. Overall mortality (5.4% vs 6.9%, p = 0.75) and graft loss (10.8% vs 5.3%, p = 0.23) were also similar at 24-month follow-up. CONCLUSION(S) The high-dose corticosteroid dosing in the RTRs during COVID-19 appears to be associated with increased infectious complications over long-term although the overall patient and graft survival was similar.