COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study

Abstract

Background COVID-19 has exposed hemodialysis patients and kidney transplant recipients to an unprecedented life-threatening infectious disease raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. The present study investigated the association of type of KRT with COVID-19 severity adjusting for differences in individual characteristics. Methods Data on kidney transplant recipients and hemodialysis patients diagnosed with COVID-19 between February 1st and December 1st 2020 were retrieved from ERACODA. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HR) for 28-day mortality risk in all patients and in the subsets who were tested because of symptoms Results In total, 1,670 patients (496 functional kidney transplant and 1,174 hemodialysis) were included. 16.9% of kidney transplant and 23.9% of hemodialysis patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in kidney transplant recipients compared with hemodialysis patients (HR: 0.67, 95%CI: 0.52-0.85). In a fully adjusted model, the risk was 78% higher in kidney transplant recipients (HR: 1.78, 95%CI: 1.22-2.61) compared with hemodialysis patients. This association was similar in patients tested because of symptoms (fully adjusted model HR: 2.00, 95%CI: 1.31-3.06). This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, ICU admission, mortality beyond 28 days) and across subgroups. Conclusions Kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients; they therefore require specific infection mitigation strategies.

Kidney transplantation and patients who decline SARS‐CoV‐2 vaccination: an ethical framework

“…Data from our own cohorts in London have shown that although COVID-19 infections were more common in waitlisted patients, COVID-19-associated mortality is higher in transplant recipients (hazard ratio 3.36) [7]; this has also been demonstrated in a national UK registry-based cohort analysis [8]. A similar increase in the risk of more severe disease in kidney transplant recipients as compared with haemodialysis patients has been reported in both retrospective and prospective analyses of European registry data [9,10]. There is further concern that SARS-CoV-2 infection in the immediate post-transplant period is likely to bring significant additional risk of mortality [10].…”

“…A similar increase in the risk of more severe disease in kidney transplant recipients as compared with haemodialysis patients has been reported in both retrospective and prospective analyses of European registry data [9,10]. There is further concern that SARS-CoV-2 infection in the immediate post-transplant period is likely to bring significant additional risk of mortality [10]. This risk can be compounded by other COVID-associated risk factors, including age, diabetes and obesity [11][12][13].…”

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…However, a recent multicenter study reported that the risk of COVID-19-related death was 78% higher in KTRs compared with hemodialysis patients after adequate adjustments for age, sex, frailty, and comorbidities. The mortality risk was radically higher during the first post-transplant year [ 11 ]. Results from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry from 2020 indicated that COVID-19-attributed mortality was 20.0% for patients on dialysis and 19.9% for KTRs [ 12 ].…”

Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study

“…Different from Jager et al's study [4], we had a more comprehensive adjustment for baseline variables and comorbidities. Unlike the ERACODA study [10], our population comprised a higher proportion of non-Caucasian patients (40 vs. 15%) and did not include asymptomatic patients. Also, we carried out subgroup analysis and used propensity scores to match the two cohorts.…”

“…However, this was not the study's primary objective, and estimates were not adjusted for several potential confounders [4]. Recently, the ERACODA registry reported an increased risk of mortality in transplant compared with dialysis [10]. However, ethnicity, practices, and Covid-19 care worldwide are not uniform and may lead to differences in outcomes.…”