Incidence of COVID-19 and Identification of Possible Risk Factors Associated with COVID-19 in Acute Renal Transplant Recipients in Pakistan

Abstract

Background Renal transplant recipients are susceptible to increased mortality with COVID-19 infection. There is insufficient data regarding risk factors for COVID-19 disease acquisition. We aimed to identify them here. Material/Methods We enrolled Pakistani renal transplant recipients from February 10, 2020, to March 18, 2021, and actively tracked their baseline health status, transplant characteristics, comorbidities, immunosuppressive therapies, and post-transplant follow-ups until September 2021. Furthermore, we formulated 2 questionnaires for their compliance assessment with COVID-19-preventive measures. We also identified COVID-19 disease acquisition, symptomatology, and management. Results Among the 50 enrolled patients, 14 (28%) patients developed COVID-19, which is higher than the incidence observed in general Pakistani population (0.55%). Their mean age was 35.38 years ±11.69 SD years, and 82% of patients were males. The following factors were independently associated with COVID-19 disease: female gender ( P value: 0.042), diabetes mellitus ( P value: 0.002), anti-thymocyte globulin (ATG) induction ( P value: 0.006), in-person follow-ups ( P value: 0.000), prolonged immediate and late post-transplant hospital stays ( P value: 0.019 and 0.000, respectively), raised post-transplant serum creatinine ( P value: 0.019), and COVID-19 protective measures non-compliance ( P value: 0.000). Out of 14 infected recipients, 92.85% required symptomatic management and overall mortality was 0%. Conclusions Female gender, diabetes mellitus, ATG induction, in-person follow-ups, prolonged hospital stays, raised post-transplant serum creatinine, and COVID-19-protective measures non-compliance were associated with the higher acquisition of SARS-CoV-2 infection. By taking concrete measures against these risk factors, we can continue renal transplants, as overall mortality was lower than in the general Pakistani population (2%).

Risk factors for SARS-CoV-2 pneumonia among renal transplant recipients in Beijing Omicron wave

“…Several studies compared the baseline serum creatinine between cadaveric and living RTRs with SARS-CoV-2 infection and found that cadaveric RTRs had significantly higher mean creatinine ( 8 ). The findings of the study in Pakistan also reported that a higher post-transplant serum creatinine ( P = 0.019) was positively associated with COVID-19 infection ( 9 ). Compared to the general population, the creatinine level in RTRs was higher and more likely to develop acute kidney injury ( P = 0.001) ( 25 ).…”

“…According to the imaging characteristics, 76.3% of the patients developed SARS-CoV-2 pneumonia, higher than the number of previous COVID-19 infections that occurred in India (50%) ( 8 ). Only one previous study in Pakistan identified the possible risk factors associated with COVID-19 infection in renal transplant recipients ( 9 ), but no study in the literature assessed the risk factors of SARS-CoV-2 pneumonia that occurred in RTRs with SARS-CoV-2 infection.…”