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

Abstract

Kidney transplant (KT) recipients with COVID-19 are at high risk of poor outcomes because of comorbidities and long-term immunosuppressive therapy (IST). There are little data on the effect of IST reduction and early graft function after COVID-19. We conducted a retrospective study on 45 consecutive KT recipients followed at the University Hospital of Modena who tested positive for COVID-19 by RT-PCR analysis. We detailed clinical management and outcomes of these patients. Median age of patients was 56.1 (interquartile range, [IQR] 47.3-61.1) years with a predominance of male (64.4%) and patients of Caucasian origin (91.1%). Kidney transplantation vintage was 10.1 (2.7-16) years, and more than half (55.6%) was on triple IST. Therapeutic management included antimetabolite (62.8%) and calcineurin inhibitor withdrawal (22.2%), and suspension of IST in severely ill patients. Of the 45 patients, 88.9% became symptomatic and 40% required hospitalization. Overall mortality accounted for 17.8% (n=8). There were no differences in outcomes between full- and reduced-dose IST at the end of follow-up. Overall, early graft function after COVID-19 showed a stable and unmodified kidney function in 95% of survivors. Risk factors for death were age (odds ratio [OR]: 1.19; 95% CI: 1.01-1.39), and years spent on immunosuppression (OR: 1.96; 95% CI: 0.38-10.03-4.9). One patient experienced symptomatic reinfection with COVID-19 after primary infection and anti-SARS-CoV-2 mRNA vaccine. COVID-19 impacted the graft and general survival of KT recipients. Short-term graft outcome after COVID-19 was favorable in most survivors. Age and transplantation vintage are independent predictors of death in our patients.

Allograft function predicts mortality in kidney transplant recipients with severe COVID-19: a paradoxical risk factor

“…Interestingly, we observed an improvement in AF 1 month after treatment for severe COVID-19 compared with that before infection. This phenomenon was also reported in a study from Italy, in which hospitalized KTRs had better AF after discharge than before infection, with no difference in non-hospitalized KTRs ( 28 ). However, this study did not specify whether the phenomenon occurred in patients with non-severe or severe COVID-19.…”

Factors Affecting Kidney Functions in One-Year Follow-up After COVID-19 in Kidney Transplant Patients

“…Other reasons for the deterioration in blood pressure regulation in our patients may be the discontinuation of RAS blocker drugs in the early stages of the epidemic, with the belief that ACEi or ARB drugs adversely affect the course of the disease or the fact that the virus may change the homeostasis of the renin-angiotensin-aldosterone system (RAAS) with the ACE2 interaction. 43 Longer transplantation time is associated with higher mortality and more frequent AKI during COVID-19. 5 We found that patients with a long transplantation period have more proteinuria after COVID-19.…”