COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities

Abstract

Higher rates of severe COVID‐19 have been reported in kidney transplant recipients (KTRs) compared to non‐transplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score‐matching method to compare survival and severe disease‐free survival (defined as death and/or need for intensive care unit (ICU)) incidence in hospitalized KTRs and non‐transplant control patients between 26 February and 22 May 2020. Patients were matched for risk factors of severe COVID‐19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3‐73.1) in 3 French transplant centers. After a median follow‐up of 13 days (7‐30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow‐up of 8.5 days (2‐14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched non‐transplant patients with respective 30‐days survival of 62.9% and 71% (p=0.38) and severe disease‐free 30‐days survival of 50.6% and 47.5% (p=0.91). These findings suggest that severity of COVID‐19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.

COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

“…Another interesting observation is made in the work of Chavarot et al Here, transplanted patients with COVID-19 disease were matched with other COVID-19 patients who had similar chronic comorbidities and the course of COVID disease was studied. The results showed a similar mortality rate in both collectives, so Chavarot et al concluded that the severity of COVID-19 disease was not associated with immunosuppression but with the comorbidities [ 16 ]. This conclusion confirms results already published in November by Chaudhry et al [ 17 ].…”

Effects of immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19

“…Centers for Disease Control (CDC) claims that 8 out 10 COVID-19 death in the U.S. has been reported in adults aged more 65 years and the risk of hospitalization and death increases enormously with age. [32] The effect of immunosuppression is still controversial in KT recipients [33]. Immunosuppression is known to dysregulate innate and adaptive immunity, exposing the patients to severe infections.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…12 Several multicenter studies evaluated the effect of immunosuppression on outcomes from COVID-19, none of which found an association between immunosuppression and mortality from COVID-19. 9,11,13 Compared with nontransplant patients, kidney transplant recipients are at greater risk of developing AKI (46.1% vs 11.2%, P < .001). 14 After matching comorbidities and age, severe disease incidence was similar between kidney transplant recipients and nontransplant patients; however, mortality was higher for kidney transplant recipients (17.9% vs 11.4%, P = .038).…”

“…12 Several multicenter studies evaluated the effect of immunosuppression on outcomes from COVID-19, none of which found an association between immunosuppression and mortality from COVID-19. 9,11,13…”