Follow‐up of renal transplant recipients after acute COVID‐19—A prospective cohort single‐center study

Abstract

Introduction Although most patients recover within several weeks after acute COVID‐19, some of them develop long‐lasting clinical symptoms. Renal transplant recipients have an increased mortality risk from COVID‐19. We aimed to describe complications occurring after COVID‐19 in this group of patients. Methods A prospective single‐center cohort study was conducted at University Hospital Centre Zagreb. Patients with two negative reverse transcriptase‐polymerase chain reaction (RT‐PCR) tests for SARS‐CoV‐2 after COVID‐19 were eligible for further follow‐up at our outpatient clinic. They underwent detailed clinical and laboratory assessments. The primary outcome was the development of complications after COVID‐19. Results Only 11.53% of renal transplant recipients who survived acute COVID‐19 were symptomless and free from new‐onset laboratory abnormalities during the median follow‐up of 64 days (range: 50–76 days). Three patients died from sepsis after discharge from the hospital. In 47 patients (45.2%), clinical complications were present, while 74 patients (71.2%) had one or more laboratory abnormalities. The most common clinical complications included shortness of breath (19.2%), tiredness (11.5%), peripheral neuropathy (7.7%), self‐reported cognitive impairments (5.7%), and dry cough (7.7%). Most common laboratory abnormalities included shortened activated partial thromboplastin time (50%), elevated D‐dimers (36.5%), elevated fibrinogen (30.16%), and hypogammaglobulinemia (24%). Positive RT‐PCR for cytomegalovirus (8.7%), Epstein–Barr virus (26%), or BK virus (16.3%). Multivariate analysis identified the history of diabetes mellitus and eGFR CKD‐EPI as predictors for the development of post‐COVID clinical complications. Six months after acute COVID‐19, elevated D‐dimers persisted with normalization of other laboratory parameters. Twenty‐nine patients were hospitalized, mostly with several concomitant problems. However, initially reported clinical problems gradually improved in the majority of patients. Conclusion Post‐COVID‐19 clinical and laboratory complications are frequent in the renal transplant population, in some of them associated with significant morbidity. All patients recovered from acute COVID‐19 should undergo long‐term monitoring for evaluation and treatment of complications.

Post-COVID-19 Sydrome and Decrease in Health-Related Quality of Life in Kidney Transplant Recipients after SARS-COV-2 Infection—A Cohort Longitudinal Study from the North of Poland

“…We found here that fatigue was the most common persistent symptom in KTR that was consistent with data from the long-term follow-up study of Huang et al in the general population and KTR from India [ 15 , 19 ]. Although our cohort reported feeling more breathless compared with the period before infection, it was not the dominant persistent symptom as presented earlier by Basic-Jukic in KTR and other studies from the general population [ 1 , 10 ]. It should be taken into account, however, that the course of COVID-19 in our cohort was mostly mild without significant respiratory involvement.…”

“…Six months after acute COVID-19, most of them significantly improved and had no symptoms. On the other hand, many patients required rehospitalizations for severe complications [ 10 ]. Unfortunately, they did not have the same time-point for a check-up for every patient, which makes collective analysis and comparison with other studies difficult.…”

“…In the study of Basic-Jukic et al, complications were more frequent in KTR with decreased glomerular filtration and those with diabetes mellitus [ 10 ]. Older age, female gender, hospital admission at symptom onset, initial dyspnea, and comorbidities were found to be significantly associated with an increased risk of post-COVID syndrome in the general population [ 6 , 7 , 28 ].…”

“…Kidney transplant recipients (KTR) recipients are a high-risk group for severe COVID-19, whose case fatality ratio may reach up to 30%, owing not only to their chronic immunosuppression, but also to older age and frequently associated comorbidities, including hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular complications [ 8 , 9 ]. Contrary to the general population, data on the long-term complications of COVID-19 in this particularly vulnerable group of patients are sparse and are of an exploratory nature [ 10 , 11 ]. Therefore, we aimed to evaluate the presence of post-COVID-19 syndrome and its predictors in KTR 6 months after the disease.…”

Persistent Post-COVID-19 Syndrome in Hemodialyzed Patients—A Longitudinal Cohort Study from the North of Poland

“…Six months after acute COVID-19, most of them significantly improved and had no symptoms. On the other hand, many patients from this study required rehospitalization for severe complications [ 23 ]. In our own findings, post-COVID-19 syndrome was observed in 70.1% of KTR and 26.9% of them reported at least three persistent symptoms.…”