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Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2024 Vol.25 No.6 P.529-540
Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study
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.
Key words: Coronavirus disease 2019 (COVID-19); Kidney transplant; Hospitalization; Mortality
1浙江大学医学院附属第一医院临床药学部，中国杭州市，310003
2浙江省药物临床研究与评价技术重点实验室，中国杭州市，310003
3浙江大学医学院附属第一医院肾脏病中心，中国杭州市，310003
4浙江省肾脏病防治技术研究重点实验室，中国杭州市，310003
5浙江大学肾脏病研究所，中国杭州市，310003
6浙江省肾脏与泌尿系统疾病临床创医学研究中心，中国杭州市，310003
7中国中医药管理局III级实验室，中国杭州市，310003
8浙江大学医学院附属第一医院信息中心，中国杭州市，310003
摘要：2022年12月2019冠状病毒病（COVID-19）在中国出现短期的暴发流行，大量肾移植受者在感染COVID-19后需住院治疗。本研究回顾分析了在2022年12月16日至2023年1月31日期间感染COVID-19并在浙江大学医学院附属第一医院住院治疗的肾移植受者的临床特征和预后，随访截至2023年3月31日。本研究共纳入324名患者，其中位年龄为49岁，从出现症状到入院的中位时间为13天。分别有67例（20.7%）、11例（3.4%）和148例（45.7%）患者接受了莫那匹韦、阿兹夫定和奈玛特韦/利托那韦治疗，29例（9.0%）患者接受了多种抗病毒药物治疗，48例（14.8%）接受了托珠单抗治疗，53例（16.4%）接受了巴瑞替尼治疗。其中，81例（25.0%）发生急性肾损伤（AKI），39例（12.0%）转入ICU治疗，55例（17.0%）发生真菌感染，50例（15.4%）最终发生移植肾失功。患者的28天死亡率为9.0%，截至随访终点时共有42例（13.0%）患者死亡。多因素Cox回归分析显示合并脑血管疾病、AKI出现、白介素-6（IL-6）水平大于6.8 pg/mL、每日平均糖皮质激素剂量大于50 mg以及真菌感染等因素与住院患者死亡风险增加相关。结果表明，感染COVID-19后需住院治疗的肾移植受者死亡率很高。此外，服用免疫调节剂或过迟应用抗病毒药物，并不能提高患者生存率，而且大剂量的糖皮质激素使用则会增加死亡风险。
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DOI:
10.1631/jzus.B2300538
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On-line Access:
2024-08-27
Received:
2023-10-17
Revision Accepted:
2024-05-08
Crosschecked:
2024-06-24