An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants

Abstract

Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day

Electronic health record analysis identifies kidney disease as the leading risk factor for hospitalization in confirmed COVID-19 patients

“…The majority of conditions associated with increased risk of COVID-19 related hospital admission have been suggested in previous studies, including diabetes, heart failure, hypertension, and chronic kidney disease [14][15][16]. What is striking from our results is the magnitude of the kidney disease-related risk.…”

On the need to better protect hemodialysis patients: a comment on “IMPact of the COVID-19 epidemic on the moRTAlity of kidney transplant recipients and candidates in a French Nationwide registry sTudy (IMPORTANT)”

“…In fact, 122 deaths after kidney transplantation and 60 in waitlisted patients when considering 606 and 478 COVID-19 diagnoses respectively, correspond to 19.5% mortality in kidney transplant patients and 12.5% in waitlisted patients found to be SARS-CoV-2 positive. This mortality rate is consistent with previous reports on kidney transplant recipients (about 22.8%) 2 and is even lower compared with the overall mortality in COVID-19 patients on dialysis (about 20%) 3 in the same country in the same period, even in areas of high-viral circulation. 4 The lower mortality in waitlisted dialysis patients is presumably due to the positive selection of these cases.…”

COVID-19—Lessons Learned and Questions Remaining

“…The frequency of certain clinical manifestations (fever, gastrointestinal symptoms) may differ in SOT patients, perhaps related to effects of immunosuppression [ 151–153 ]. Limited data suggest that the risks for acquisition and progression of infection to clinical symptoms may be higher than in the general population, related to behavioral factors such as more frequent contact with the healthcare system and biological factors such as co-morbidities and the effects of immunosuppression [ 151 ]. For patients requiring hospitalization due to COVID-19, short-term morbidity and mortality appear to be high and generally similar to non-SOT populations.…”

“…For patients requiring hospitalization due to COVID-19, short-term morbidity and mortality appear to be high and generally similar to non-SOT populations. Available evidence suggests that COVID-19-related mortality in SOT recipients is largely driven by underlying co-morbidities rather than by immunosuppression [ 151–153 ]. In fact, similar mortality despite higher comorbidities is seen in hospitalized SOT COVID patients, hinting at the possible modulation of illness severity by immunosuppression.…”