Clinical outcomes of post‐renal transplant patients with COVID‐19 infection in the ICU: A single‐center case series

Shaikh, Nissar; Khatib, Mohamad; Alwraidat, Mohammad; Ananthegowda, Dore C.; Othman, Muftah; Aroos, Asra; Jujjavarapu, Sagar; Banerjee, Siwalik; Nasir, Zishan; Mohamed, Ahmed S.; Elshafei, Moustafa; Almaslamani, Muna; Nashwan, Abdulqadir J.

doi:10.1002/ccr3.4513

Cited by 3 publications

(6 citation statements)

References 12 publications

(39 reference statements)

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“…For immunosuppression, calcineurin inhibitors, prednisone, and azathioprine were maintained or decreased, while mycophenolate mofetil (MMF) was discontinued, and tacrolimus dosage was reduced during treatment [27][28][29][30][31][32][33][34]. Most patients, despite risk factors for poor outcomes, gradually improved [27][28][29][30][31][32][33][34]. These findings are consistent with previous studies indicating high mortality rates among KTRs.…”

Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...supporting

confidence: 84%

“…Overall treatments included hydroxychloroquine, azithromycin, prednisone, convalescent plasma, and remdesivir [27][28][29][30][31][32][33]. For immunosuppression, calcineurin inhibitors, prednisone, and azathioprine were maintained or decreased, while mycophenolate mofetil (MMF) was discontinued, and tacrolimus dosage was reduced during treatment [27][28][29][30][31][32][33][34]. Most patients, despite risk factors for poor outcomes, gradually improved [27][28][29][30][31][32][33][34].…”

Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...mentioning

confidence: 99%

“…In this review, several studies indicated that different treatment regimens affected KTR outcomes, but the overarching theme is that taking patients off immunosuppressants affected them negatively [27][28][29][30][31][32][33][34]. Of 132 COVID-19 patients who were hospitalized and monitored, the overall mortality was found to be 20.5%, with a significant increase (37.8%) in patients needing hospitalization.…”

Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...mentioning

confidence: 99%

“…Importantly, the mortality rate of COVID-19 KTRs remained high despite the lack of viral coinfections [ 30 ]. However, according to Shaikh et al, eight patients developed acute renal allograft dysfunction due to sepsis caused by the immunosuppressed status and related comorbidities [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

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A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States

Karas¹,

Bernal²,

Díaz³

et al. 2023

Cureus

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SARS-CoV-2, responsible for the COVID-19 pandemic, is a highly infectious virus that quickly became and continues to be a public health emergency, given the severe international implications. Immunocompromised patients, such as those undergoing kidney transplantation, are at an increased risk for severe illness from COVID-19 and require hospitalization for more aggressive treatment to ensure survival. COVID-19 has been infecting kidney transplant recipients (KTRs), affecting their treatment protocols, and threatening their survival. The objective of this scoping review was to summarize the published literature regarding the impact of COVID-19 on KTRs in the United States in terms of prevention, various treatment protocols, COVID-19 vaccination, and risk factors. The databases such as PubMed, MEDLINE/Ebsco, and Embase were used to search for peer-reviewed literature. The search was restricted to articles that were published on KTRs in the United States from January 1, 2019, to March 2022. The initial search yielded 1,023 articles after removing duplicates, leading to a final selection of 16 articles after screening with inclusion and exclusion criteria. Four domains emerged from the review: (1) impacts of COVID-19 on performing kidney transplants, (2) impacts of COVID-19 vaccinations on KTRs, (3) outcomes of treatment regiments for KTRs with COVID-19, and (4) risk factors associated with an increased mortality rate of COVID-19 in KTRs. Waitlisted patients for kidney transplants had a higher risk of mortality compared to nontransplant patients. COVID-19 vaccinations in KTRs are found to be safe, and the immune response can be improved by placing patients on a low dose of mycophenolate before vaccination. Withdrawal of immunosuppressants showed a mortality rate of 20% without increasing the rate of acute kidney injury (AKI). There is evidence to support that kidney transplantation with the accompanying immunosuppressant regimen can provide KTRs with better COVID-19 infection outcomes compared to waitlisted patients. Hospitalization, graft dysfunction, AKI, and respiratory failure were the most common risk factors that increased the risk of mortality in COVID-19-positive KTRs. Withdrawing KTRs from immunosuppressive drugs increased the mortality rate. Further studies are needed to investigate the effects of specific drugs and dosages on the severity and mortality rate of COVID-19 in KTRs.

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Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...supporting

confidence: 84%

Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...mentioning

confidence: 99%

Section: Domain 3: Outcomes Of Various Treatment Regimens For Ktrs Wi...mentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States

Karas¹,

Bernal²,

Díaz³

et al. 2023

Cureus

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“…Other factors which increase the risk for COVID-19 infection in kidney transplant patients include underlying diseases such as hypertension and diabetes (16). Our results show that around 46% of kidney transplant patients had hypertension and 31% of them had diabetes, which is consistent with the results of the study by Shaikh et al (17).…”

Section: Discussionsupporting

confidence: 92%

Clinical manifestations and laboratory findings and mortality rate of kidney transplant recipients infected with COVID-19

et al. 2022

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Introduction: The emergence of a novel coronavirus (COVID-19) in late December 2019 and its rapid global spread has led World Health Organization (WHO) to introduce it as a very dangerous pandemic. People with underlying disease and a history of organ transplantation are at higher risk for COVID-19 disease compared with healthy people. Objectives: In the present study, clinical and laboratory manifestations in the patients with COVID-19 with a history of kidney transplantation has been investigated. Patients and Methods: This study conducted on 103 COVID-19-positive kidney transplant patients as a descriptive epidemiological study. Clinical and laboratory symptoms of hospitalized renal transplanted patients have been assessed. Statistical analysis of the collected data conducted using SPSS (Statistical Package for Social Sciences, version 22). Results: This study consisted of 103 COVID-19 patients with a history of kidney transplant, of which 64 males (62.1%) and 39 females (37.9%) with an average age of 48.5 ± 13.1 years. The most common clinical manifestations were headache (67%) and shortness of breath (66%). Elevated lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) has been observed in 100%, 98.1% and 93.2% of patients, respectively. In 12.6% and 41.7% of patients, the degree of lung involvement was above 75% and 50%-75%, respectively. Moreover, 79.6% of patients has been discharged after improved, while 20.4% of patients died. Conclusion: We found, kidney transplantation may increase COVID-19-related mortality when compared to COVID-19-related mortality in the general population.

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Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study

Nashwan¹,

Abujaber²,

Wraidat³

et al. 2023

Cureus

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Introduction: The total number of ICU admissions for COVID-19 patients has increased steadily. Based on the research team's clinical observations, many patients developed rhabdomyolysis, but few cases were reported in the literature. This study explores the incidence of rhabdomyolysis and its outcomes, like mortality, the need for intubation, acute kidney injury, and the need for renal replacement therapy (RRT).Methods: We retrospectively reviewed the characteristics and outcomes of patients admitted to the ICU at a COVID-19-designated hospital in Qatar between March and July 2020. Logistic regression analysis was used to determine factors associated with mortality.Results: 1079 patients with COVID-19 were admitted to the ICU, and 146 developed rhabdomyolysis. Overall, 30.1% died (n = 44), and 40.4% developed Acute Kidney Injury (AKI) (n = 59), with only 19 cases (13%) recovering from the AKI. AKI was significantly associated with increased mortality rates among rhabdomyolysis patients. Moreover, significant differences were found between groups regarding the subject's age, calcium level, phosphorus level, and urine output. However, the AKI was the best predictor of mortality for those who got the COVID-19 infection and rhabdomyolysis. Conclusion: Rhabdomyolysis increases the risk of death in COVID-19 patients admitted to the ICU. The strongest predictor of a fatal outcome was acute kidney injury. The findings of this study emphasize the importance of early identification and prompt treatment of rhabdomyolysis in patients with severe COVID-19.

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Clinical outcomes of post‐renal transplant patients with COVID‐19 infection in the ICU: A single‐center case series

Cited by 3 publications

References 12 publications

A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States

A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States

Clinical manifestations and laboratory findings and mortality rate of kidney transplant recipients infected with COVID-19

Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study

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