COVID-19 Infection in Kidney Transplant Recipients: Disease Incidence and Clinical Outcomes

Abstract

BackgroundCOVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined.MethodsWe enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform.ResultsAmong 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19–positive patients.ConclusionsPatients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.

Sex matters: COVID-19 in kidney transplantation

“…Likewise, accounting for the higher proportion of transplant recipients who are male, the incidence of COVID-19 after kidney transplantation also appears to be similar in both sexes. 1 However, after controlling for age and comorbidities, COVID-19-attributable mortality rates in the general population are 1.5 to 2.0-fold higher in males than females. 3 In contrast, while kidney transplantation has been associated with as much as a 10-fold higher mortality with COVID-19 disease compared with the general population, 2 no consistent sex differences in COVID-19-related mortality have been observed in kidney transplant recipients.…”

“…The estimated incidence of SARS-CoV-2 infection and COVID-19 disease in patients on dialysis and with kidney transplants exceeds that of the general population by as much as 15-fold. 1 The risk of complications and death associated with COVID-19 is also considerably higher among kidney transplant recipients. 2 Reasons for the observed differences between transplant recipients and the general population may be attributed to multiple comorbidities, and the suppressed immune system in these vulnerable patients.…”

“… 3 In contrast, while kidney transplantation has been associated with as much as a 10-fold higher mortality with COVID-19 disease compared with the general population, 2 no consistent sex differences in COVID-19-related mortality have been observed in kidney transplant recipients. 1 While sex differences in case fatality rates in the transplant population may emerge as more data accumulate, the apparent lack of sex differences in case fatality rates in transplant patients to date may reflect sex-related differences in the effects of immunosuppression.…”

Management of COVID-19 in special populations with kidney disease

“…3 Kidney transplant recipients (KTRs) are particularly vulnerable to higher morbidity and mortality in the setting of COVID-19 infection due to the higher incidence of comorbid conditions compared to the general population as well as a depressed immune state. 3,14 In a prospective study consisting of 1,216 KTRs, the incidence of COVID-19 infection was found to be 5% with a mortality rate of 24% among COVID-19-positive patients compared to a mortality rate ranging from 1% to 5% in the general population. 14 Fever is the most common reported symptom of COVID-19 in KTRs, followed by cough, dyspnea, and gastrointestinal symptoms; some patients present with mild or atypical symptoms such as conjunctivitis and a normal white blood cell count.…”

“…14 Fever is the most common reported symptom of COVID-19 in KTRs, followed by cough, dyspnea, and gastrointestinal symptoms; some patients present with mild or atypical symptoms such as conjunctivitis and a normal white blood cell count. [14][15][16][17] Thus, mild and atypical symptoms should prompt testing for COVID-19 in KTRs.…”