A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India

Abstract

Data comparing the clinical spectrum of COVID-19 in kidney transplant recipients (KTRs) during the first and second waves of the pandemic in India is limited. Our single-center retrospective study compared the clinical profile, mortality, and associated risk factors in KTRs with COVID-19 during the 1st wave (1st February 2020 to 31st January 2021) and the second wave (1st March-31st August 2021). 156 KTRs with PCR confirmed SARS-CoV-2 infection treated at a tertiary care hospital in New Delhi during the 1st and the second waves were analyzed. The demographics and baseline transplant characteristics of the patients diagnosed during both waves were comparable. Patients in the second wave reported less frequent hospitalization, though the intensive care unit (ICU) and ventilator requirements were similar. Strategies to modify immunosuppressants such as discontinuation of antinucleoside drugs with or without change in calcineurin inhibitors and the use of steroids were similar during both waves. Overall patient mortality was 27.5%. The demographics and baseline characteristics of survivors and nonsurvivors were comparable. A higher percentage of nonsurvivors presented with breathing difficulty, low SpO2, and altered sensorium. Both wave risk factors for mortality included older age, severe disease, ICU/ventilator requirements, acute kidney injury (AKI) needing dialysis, Chest Computerized Tomographic (CT) scan abnormalities, and higher levels of inflammatory markers particularly D-dimer and interleukin-6 levels. Conclusions. KTRs in both COVID-19 waves had similar demographics and baseline characteristics, while fewer patients during the second wave required hospitalization. The D-dimer and IL-6 levels are directly correlated with mortality.

The effects of COVID‐19 on pediatric and adult solid organ transplant recipients and the emergence of telehealth

“…Visual inspection of the funnel plot for publication bias showed asymmetry. Upon subgroup analysis based on the type of transplant recipients (kidney, liver, heart, lung, or mixed), the reported proportion of patients with AKI was 28% (95% CI: 0.22 to 0.36; 10 studies; I 2 = 92%) in studies reporting mixed SOTRs 12,15,17,21,26,27,29,32,39,41 ; 39% (95%CI: 0.35 to 0.44; two studies; I 2 = 0%) in kidney transplant recipients 36,42 and 31% (95% CI: 0.26 to 0.37; one study), 28 and the test for subgroup difference was significant (Figure 10).…”

“…On performing subgroup analysis based on the type of transplant recipients (kidney, liver, heart, lung, or mixed), the mortality in kidney transplant recipients was 25% (95% CI: 0.18; 0.35; five studies), 13,14,35,36 14% (95% CI: 0.11; 0.18; 22 studies) 12,15,16,18,19,21,23–27,29–34,37–41 in mixed SOTRs; 20% (95% CI: 0.13; 0.29; one study) 28 in liver transplant recipients; 27% (95% CI: 0.13; 0.47; one study) 20 in heart transplant recipients; and 8% (95% CI: 0.01; 0.3; one study) 22 in lung transplant recipients. There was considerable heterogeneity ( I 2 = 90%), and the test for subgroup difference was significant (Figure 7).…”

“…Acute kidney injury (AKI) was reported in 13 studies, and the pooled AKI rate was 31% (95% CI: 26% to 37%) 12,15,17,21,26–29,32,36,39,41,42 [Figure 9]. Bajaut's plot showed study by Hadi Y et al unduly influenced heterogeneity and pooled estimates.…”

“…Acute kidney injury (AKI) was reported in 13 studies, and the pooled AKI rate was 31% (95% CI: 26% to 37%) 12,15,17,21,[26][27][28][29]32,36,39,41,42 [Figure 9]. Bajaut's plot showed F I G U R E 1 PRISMA flow diagram for COVID-19 involvement in solid organ transplant recipients.…”

Epidemiology of Invasive Fungal Infections in Solid Organ Transplant Recipients: an Indian Perspective

“…The mortality rate of CAM was 26.2%, while pulmonary mucormycosis was 100% fatal [ 35 ]. Further, on comparing the first and second wave of covid-19 in India, it was observed that the rate of fungal culture positivity in RT patients and mortality was significantly higher during the second wave than in the first wave [ 36 ], consistent with the outbreak of mucormycosis during the second wave of covid-19 in India.…”