COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium

Abstract

Kidney transplant recipients may be at a high risk of developing critical coronavirus disease 2019 (COVID‐19) illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the United States, Italy, and Spain who tested positive for COVID‐19. Clinical presentation, laboratory values, immunosuppression, and treatment strategies were reviewed, and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9845 kidney transplant recipients across centers, 144 were hospitalized due to COVID‐19 during the 9‐week study period. Of the 144 patients, 66% were male with a mean age of 60 (±12) years, and 40% were Hispanic and 25% were African American. Prevalent comorbidities included hypertension (95%), diabetes (52%), obesity (49%), and heart (28%) and lung (19%) disease. Therapeutic management included antimetabolite withdrawal (68%), calcineurin inhibitor withdrawal (23%), hydroxychloroquine (71%), antibiotics (74%), tocilizumab (13%), and antivirals (14%). During a median follow‐up period of 52 days (IQR: 16‐66 days), acute kidney injury occurred in 52% cases, with respiratory failure requiring intubation in 29%, and the mortality rate was 32%. The 46 patients who died were older, had lower lymphocyte counts and estimated glomerular filtration rate levels, and had higher serum lactate dehydrogenase, procalcitonin, and interleukin‐6 levels. In sum, hospitalized kidney transplant recipients with COVID‐19 have higher rates of acute kidney injury and mortality.

A Systematic Review of COVID-19 and Kidney Transplantation

“…11 , 12 In the largest multicentre series, Cravedi et al reported 32% mortality in 144 inpatients although it did not specify how many recovered to discharge, while Kates et al reported 28-day mortality as 18% from its dataset where 254/318 patients were hospitalised. 10 , 17 Of other studies from which inpatient mortality could be calculated, it was 7/39 patients (18%) in Lubetzky et al across New York, 22 6/29 patients (21%) in both Rodriguez-Cubillo et al in Madrid and Chen et al in New York City, 23 , 27 15/42 patients (36%) in Bossini et al in Brescia and 9/25 patients (36%) Mohamed et al in London. 20 , 25 …”

“…12 , 13 , 14 , 23 Cravedi et al excluded any patients from studies which had already been published but these were smaller studies not included in our summary. 17 Kates et al did not report which centres submitted data to its registry but there were over 50, of whom >98% were from the USA; 10 our review includes six other studies with data from USA which may have overlapped. Some centres from USA and Italy reported in our review are likely to have contributed to the surveys published by Boyarsky et al and Vistoli et al 18 , 19…”

“…11 , 15 , 16 Kates et al reported on data entered to a registry by over 50 transplant centres, almost all from the USA, 10 while Cravedi et al was a report of a consortium registry of 12 transplant centres across USA, Italy and Spain. 17 Boyarsky et al and Vistoli et al were cross-sectional reports of national surveys from USA and Italy respectively. 18 , 19 The remaining studies were either single-centre or small multi-centre case series of either inpatients, or both inpatient and outpatient kidney transplant recipients with COVID-19.…”

“…Cravedi et al found 7% increased mortality in people aged >60 years compared to those aged ≤60 years. 17 In subgroup reports from the national registry in Spain, Pascual et al reported 46% mortality amongst patients within 60 days of transplantation, while Pérez-Sáez reported 33% mortality amongst patients with severe COVID-19 treated with tocilizumab. 13 , 14 …”

Handling immune-suppressive therapies during SARS-CoV-2 pandemic: insights from pediatric datasets

“…A study from Brescia, Lombardy, the Italian region with one of the highest rates of SARS-CoV-2 worldwide, reported an incidence of COVID-19 of 4.6% among a population of 1200 kidney transplant recipients and a mortality rate of 27% (15/55), which is higher than the rates reported in the general population [ 3 ]. A more recent survey, involving a population of 9845 kidney transplant recipients across 14 centers worldwide (TANGO consortium), confirmed the Italian data and reported an incidence of infection of 1.5%, with a mortality rate of 32% (44/144) during a median follow-up of 52 days [ 4 ].…”