Similar articles

Abstract: BackgroundFollowing the short-term outbreak of coronavirus disease 2019 (COVID-19) in December 2022 in China, clinical data on kidney transplant recipients (KTRs) with COVID-19 are lacking.
MethodsWe conducted a single-center retrospective study to describe the clinical features, complications, and mortality rates of hospitalized KTRs infected with COVID-19 between Dec. 16, 2022 and Jan. 31, 2023. The patients were followed up until Mar. 31, 2023.
ResultsA total of 324 KTRs with COVID-19 were included. The median age was 49 years. The median time between the onset of symptoms and admission was 13 d. Molnupiravir, azvudine, and nirmatrelvir/ritonavir were administered to 67 (20.7%), 11 (3.4%), and 148 (45.7%) patients, respectively. Twenty-nine (9.0%) patients were treated with more than one antiviral agent. Forty-eight (14.8%) patients were treated with tocilizumab and 53 (16.4%) patients received baricitinib therapy. The acute kidney injury (AKI) occurred in 81 (25.0%) patients and 39 (12.0%) patients were admitted to intensive care units. Fungal infections were observed in 55 (17.0%) patients. Fifty (15.4%) patients lost their graft. The 28-d mortality rate of patients was 9.0% and 42 (13.0%) patients died by the end of follow-up. Multivariate Cox regression analysis identified that cerebrovascular disease, AKI incidence, interleukin (IL)‍-6 level of >6.8 pg/mL, daily dose of corticosteroids of >50 mg, and fungal infection were all associated with an increased risk of death for hospitalized patients.
ConclusionsOur findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality. The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival, while higher doses of corticosteroids may increase the death risk.

在2019冠状病毒病暴发流行期间感染并住院治疗的肾移植受者的临床特征与预后：一项中国单中心队列研究

[1]AhmadFB, CisewskiJA, XuJQ, et al., 2023. COVID-19 mortality update – United States, 2022. MMWR Morb Mortal Wkly Rep, 72(18):493-496.

[2]AveryRK, 2022. Update on COVID-19 therapeutics for solid organ transplant recipients, including the omicron surge. Transplantation, 106(8):1528-1537.

[3]AzziY, BartashR, ScaleaJ, et al., 2021. COVID-19 and solid organ transplantation: a review article. Transplantation, 105(1):37-55.

[4]BergerB, HazzanM, KamarN, et al., 2022. Absence of mortality differences between the first and second COVID-19 waves in kidney transplant recipients. Kidney Int Rep, 7(12):2617-2629.

[5]BernalE, GimenoL, AlcarazMJ, et al., 2021. Activating killer-cell immunoglobulin-like receptors are associated with the severity of coronavirus disease 2019. J Infect Dis, 224(2):229-240.

[6]CaillardS, AnglicheauD, MatignonM, et al., 2020. An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Kidney Int, 98(6):1549-1558.

[7]ChanL, ChaudharyK, SahaA, et al., 2021. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol, 32(1):151-160.

[8]ChaudhuriD, SasakiK, KarkarA, et al., 2021. Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis. Intensive Care Med, 47(5):521-537.

[9]COVID-19 Excess Mortality Collaborators, 2022. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet, 399(10334):1513-1536.

[10]DanielE, SekulicM, KudoseS, et al., 2021. Kidney allograft biopsy findings after COVID-19. Am J Transplant, 21(12):4032-4042.

[11]DaoudA, AlqassiehA, AlkhaderD, et al., 2021. Immunosuppression in kidney transplant recipients with COVID-19 infection – where do we stand and where are we heading? Ren Fail, 43(1):273-280.

[12]FangXY, LiS, YuH, et al., 2020. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging, 12(13):‍‍‍12493-12503.

[13]FarkashEA, WilsonAM, JentzenJM, 2020. Ultrastructural evidence for direct renal infection with SARS-CoV-2. J Am Soc Nephrol, 31(8):1683-1687.

[14]FavàA, CucchiariD, MonteroN, et al., 2020. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: a multicentric cohort study. Am J Transplant, 20(11):3030-3041.

[15]GangneuxJP, DannaouiE, FekkarA, et al., 2022. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med, 10(2):180-190.

[16]GérardAO, BarbosaS, AnglicheauD, et al., 2022. Association between maintenance immunosuppressive regimens and COVID-19 mortality in kidney transplant recipients. Transplantation, 106(10):2063-2067.

[17]GuptaS, WangW, HayekSS, et al., 2021. Association between early treatment with tocilizumab and mortality among critically ill patients with COVID-19. JAMA Intern Med, 181(1):41-51.

[18]HajibarataliB, AminiH, DaliliN, et al., 2023. Clinical outcomes of kidney recipients with COVID-19 (COVID-19 in kidney recipients). Transpl Immunol, 76:101772.

[19]HartzellS, BinS, BenedettiC, et al., 2020. Evidence of potent humoral immune activity in COVID-19-infected kidney transplant recipients. Am J Transplant, 20(11):3149-3161.

[20]JimenoS, VenturaPS, CastellanoJM, et al., 2021. Prognostic implications of neutrophil-lymphocyte ratio in COVID-19. Eur J Clin Invest, 51(1):e13404.

[21]KlopfensteinT, GendrinV, Kadiane-OussouNJ, et al., 2022. Tocilizumab in COVID-19 pneumonia: practical proposals based on a narrative review of randomised trials. Rev Med Virol, 32(1):e2239.

[22]KremerD, PietersTT, VerhaarMC, et al., 2021. A systematic review and meta-analysis of COVID-19 in kidney transplant recipients: lessons to be learned. Am J Transplant, 21(12):3936-3945.

[23]KronbichlerA, GaucklerP, WindpesslM, et al., 2020. COVID-19: implications for immunosuppression in kidney disease and transplantation. Nat Rev Nephrol, 16(7):365-367.

[24]MahalingasivamV, SuGB, IwagamiM, et al., 2022. COVID-19 and kidney disease: insights from epidemiology to inform clinical practice. Nat Rev Nephrol, 18(8):485-498.

[25]MallhiTH, KhanYH, AlzareaAI, et al., 2022. Incidence, risk factors and outcomes of acute kidney injury among COVID-19 patients: a systematic review of systematic reviews. Front Med (Lausanne), 9:973030.

[26]MassetC, Gautier-VargasG, CantarovichD, et al., 2022. Occurrence of de novo donor-specific antibodies after COVID-19 in kidney transplant recipients is low despite immunosuppression modulation. Kidney Int Rep, 7(5):983-992.

[27]MendozaMA, RanganathN, ChesdachaiS, et al., 2023. Immunomodulators for severe coronavirus disease-2019 in transplant patients: do they increase the risk of secondary infection? Transpl Infect Dis, 25(2):e14050.

[28]NabL, ParkerEPK, AndrewsCD, et al., 2023. Changes in COVID-19-related mortality across key demographic and clinical subgroups in England from 2020 to 2022: a retrospective cohort study using the OpenSAFELY platform. Lancet Public Health, 8(5):e364-e377.

[29]NadimMK, ForniLG, MehtaRL, et al., 2020. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol, 16(12):747-764.

[30]National Institutes of Health (US), 2021. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. National Institutes of Health (US), Bethesda, USA. https://pubmed.ncbi.nlm.nih.gov/34003615

[31]NgJH, HirschJS, HazzanA, et al., 2021. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis, 77(2):204-215.e1.

[32]NimmoA, GardinerD, Ushiro-LumbI, et al., 2022. The global impact of COVID-19 on solid organ transplantation: two years into a pandemic. Transplantation, 106(7):1312-1329.

[33]PereiraMR, AversaMM, FarrMA, et al., 2020. Tocilizumab for severe COVID-19 in solid organ transplant recipients: a matched cohort study. Am J Transplant, 20(11):‍‍3198-3205.

[34]Pérez-SáezMJ, BlascoM, Redondo-PachónD, et al., 2020. Use of tocilizumab in kidney transplant recipients with COVID-19. Am J Transplant, 20(11):3182-3190.

[35]RECOVERYCollaborative Group, 2021. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet, 397(10285):1637-1645.

[36]RECOVERYCollaborative Group, 2022. Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. Lancet, 400:359-368.

[37]RECOVERYCollaborative Group, 2023. Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet, 401(10387):1499-1507.

[38]RichierQ, JachietV, BonnemainsV, et al., 2022. Tocilizumab and COVID-19: timing of administration assessment. Infect Dis Now, 52(1):31-34.

[39]RoncoC, ReisT, Husain-SyedF, 2020. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med, 8(7):738-742.

[40]SaravolatzLD, DepcinskiS, SharmaM, 2023. Molnupiravir and nirmatrelvir-ritonavir: oral coronavirus disease 2019 antiviral drugs. Clin Infect Dis, 76(1):165-171.

[41]SinghAK, OksM, HuskG, et al., 2021. Impact of timing of tocilizumab use in hospitalized patients with SARS-CoV-2 infection. Respir Care, 66(12):1805-1814.

[42]SuH, YangM, WanC, et al., 2020. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int, 98(1):219-227.

[43]TalicS, ShahS, WildH, et al., 2021. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ, 375:e068302.

[44]TanBWL, TanBWQ, TanALM, et al., 2023. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: an international multi-centre observational cohort study. eClinicalMedicine, 55:101724.

[45]TatumD, TaghaviS, HoughtonA, et al., 2020. Neutrophil-to-lymphocyte ratio and outcomes in Louisiana COVID-19 patients. Shock, 54(5):652-658.

[46]TuJY, MoXQ, ZhangXD, et al., 2022. Effects of different corticosteroid therapy on severe COVID-19 patients: a meta-analysis of randomized controlled trials. Expert Rev Respir Med, 16(1):79-89.

[47]van GrootveldR, van der BeekMT, JanssenNAF, et al., 2023. Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy. J Crit Care, 76:154272.

[48]WagnerC, GrieselM, MikolajewskaA, et al., 2021. Systemic corticosteroids for the treatment of COVID-19. Cochrane Database Syst Rev, 8(8):CD014963.

[49]WangAX, KoffA, HaoDN, et al., 2022. Effect of nirmatrelvir/ritonavir on calcineurin inhibitor levels: early experience in four SARS-CoV-2 infected kidney transplant recipients. Am J Transplant, 22(8):2117-2119.

[50]WeissA, HendrickxR, StensgaardE, et al., 2023. Kidney transplant and dialysis patients remain at increased risk for succumbing to COVID-19. Transplantation, 107(5):1136-1138.

[51]WillicombeM, ThomasD, McAdooS, 2020. COVID-19 and calcineurin inhibitors: should they get left out in the storm? J Am Soc Nephrol, 31(6):1145-1146.

[52]ZhangWJ, HanF, WuXF, et al., 2022. COVID-19 in the immunocompromised population: data from renal allograft recipients throughout full cycle of the outbreak in Hubei province, China. Chin Med J, 135(2):228-230.

[53]ZhouZF, KuangH, MaYX, et al., 2021. Application of extracorporeal therapies in critically ill COVID-19 patients. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 22(9):‍‍701-717.

[54]ZhuL, GongNQ, LiuB, et al., 2020. Coronavirus disease 2019 pneumonia in immunosuppressed renal transplant recipients: a summary of 10 confirmed cases in Wuhan, China. Eur Urol, 77(6):748-754.