Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry

Abstract

SARS‐CoV‐2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID‐19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID‐19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti‐COVID‐19 treatment in the second wave (July–December) than in the first one (March–June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post‐KT should be considered when selecting recipients for transplantation in the COVID‐19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.

Consequences of the first and secondCOVID‐19 wave on kidney transplant recipients at a large Indian transplant centre

“…KTRs were significantly younger, had less pneumonia and received less frequently anti‐COVID‐19 treatment in the second wave, and the overall mortality was lower but similar in critical patients. 20 The observed high‐case fatality in the elderly transplant recipients could be due to age‐associated comorbidities. 30 Our study had findings similar to this analysis of the Spanish Registry.…”

“… 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Likewise, data comparing the characteristics of the infection in kidney transplant recipients (KTR) between two COVID‐19 waves are scarce. 19 , 20 , 21 There are reports on the effects of the first wave on KTR in India; 22 , 23 , 24 , 25 however, there are no data currently available on the effects of the second wave from India.…”

Analysis of COVID 19 Infection in Chronic Kidney Disease and Kidney Transplant Patients in Pandemic Hospital: What Has the Last Year Taught Us?

“…The first six months of intensive immunosuppression following the transplant and age >65 years were predictors for mortality in this study. (13) One of the interesting data of our study is that mortality was found to be lower in univariate analyzes in RT cases whose post-transplant outpatient follow-up was performed in our center (p: 0.02). The mortality rate was %7.5 (n: 3) out of 40 patients treated in our center.…”

“…Nasal oxygen support was sufficient for the patients hospitalized in the clinic. The median length of stay of the inpatients was found to be 9.5 (5)(6)(7)(8)(9)(10)(11)(12)(13), and the median length of stay in the intensive care unit was 4.5 (1.25-10.75). Fıfteen of our patients (20.8%) died.…”

COVID-19 and the kidney: time to take a closer look

“…Kidney transplant recipients might be extremely vulnerable to COVID-19 infection as they are immunosuppressed and commonly characterised by increased comorbidity. The Spanish Registry prospectively included 1011 kidney transplant recipients with COVID-19, followed until death or recovery and reported that advanced age, pneumonia and kidney transplant performed in the last six months before SARS-CoV-2 infection were independent predictors of mortality, whereas gastrointestinal symptoms were associated with low mortality rates [ 15 ]. Compared to the first (March–June 2020), in the second pandemic wave (July–December 2020), kidney transplant recipients infected with COVID-19 were significantly younger with reduced overall mortality rates.…”