Is COVID-19 infection more severe in kidney transplant recipients?
Aged
COVID-19
/ diagnosis
Comorbidity
Female
France
/ epidemiology
Graft Rejection
/ epidemiology
Humans
Immunosuppression Therapy
/ methods
Immunosuppressive Agents
/ therapeutic use
Incidence
Intensive Care Units
Kidney Transplantation
Male
Middle Aged
Pandemics
Propensity Score
Registries
Retrospective Studies
Risk Factors
SARS-CoV-2
Severity of Illness Index
Transplant Recipients
/ statistics & numerical data
cardiovascular disease
clinical research / practice
glomerular filtration rate (GFR)
immunosuppressive regimens
infection and infectious agents - viral
infectious disease
kidney failure / injury
kidney transplantation / nephrology
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
28
08
2020
revised:
23
11
2020
accepted:
24
11
2020
pubmed:
2
12
2020
medline:
11
3
2021
entrez:
1
12
2020
Statut:
ppublish
Résumé
There are no studies which have compared the risk of severe COVID-19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID-19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single-center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID-19 or mortality. Severe COVID-19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30-day cumulative incidence of severe COVID-19 did not differ between KTR and nontransplant patients; however, 30-day COVID-19-related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C-reactive protein (CRP) were associated with severe COVID-19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID-19-related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID-19-related mortality compared to nontransplant hospitalized patients.
Identifiants
pubmed: 33259686
doi: 10.1111/ajt.16424
pmc: PMC7753418
pii: S1600-6135(22)08464-7
doi:
Substances chimiques
Immunosuppressive Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1295-1303Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Crit Care. 2020 Mar 18;24(1):108
pubmed: 32188484
Am J Transplant. 2003 Aug;3(8):977-81
pubmed: 12859532
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
Crit Care. 2020 Apr 28;24(1):179
pubmed: 32345311
N Engl J Med. 2020 Jun 18;382(25):2475-2477
pubmed: 32329975
Crit Care. 2020 Jun 18;24(1):356
pubmed: 32552872
J Crit Care. 2011 Dec;26(6):577-85
pubmed: 21489748
PLoS Med. 2020 Sep 10;17(9):e1003321
pubmed: 32911500
Kidney Int. 2020 Jun;97(6):1083-1088
pubmed: 32354634
Cell. 2020 May 28;181(5):1036-1045.e9
pubmed: 32416070
Am J Transplant. 2020 Jul;20(7):1800-1808
pubmed: 32330343
Kidney Int. 2020 May;97(5):829-838
pubmed: 32247631
Kidney Int. 2020 May;97(5):824-828
pubmed: 32204907
Kidney Int. 2005 Feb;67(2):698-705
pubmed: 15673319
Am J Transplant. 2015 Apr;15(4):1101-4
pubmed: 25716741