tetano
Editor, Senior Moderator
Clin Transplant
. 2021 Jan 9;e14221.
doi: 10.1111/ctr.14221. Online ahead of print.
Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus-2019 (COVID-19)
Andrew D Santeusanio[SUP] 1 [/SUP], Madhav C Menon[SUP] 1 [/SUP], Caroline Liu[SUP] 2 [/SUP], Arjun Bhansali[SUP] 1 [/SUP], Niralee Patel[SUP] 1 [/SUP], Fahima Mahir[SUP] 1 [/SUP], Meenakshi Rana[SUP] 3 [/SUP], Fasika Tedla[SUP] 1 [/SUP], Ahmad Mahamid[SUP] 1 [/SUP], Yaniv Fenig[SUP] 1 [/SUP], Alexey Zendel[SUP] 1 [/SUP], Veronica Delaney[SUP] 1 [/SUP], Graciela De Boccardo[SUP] 1 [/SUP], Samira S Farouk[SUP] 1 [/SUP], Vinita Sehgal[SUP] 1 [/SUP], Rafael Khaim[SUP] 1 [/SUP], Samantha E Jacobs[SUP] 3 [/SUP], Dallas Dunn[SUP] 3 [/SUP], Timothy Sullivan[SUP] 3 [/SUP], Sarah Taimur[SUP] 3 [/SUP], Emily Baneman[SUP] 3 [/SUP], Sander Florman[SUP] 1 [/SUP], Ron Shapiro[SUP] 1 [/SUP]
Affiliations
Abstract
The influence of patient characteristics and immunosuppression management on COVID-19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single-center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID-19 between 03/15/2020-05/15/2020. Patients were followed from the date of admission, up to 1-month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 mL/min/1.73m[SUP]2[/SUP] were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR=2.05; 1.04-4.04), peak D-dimer (OR=1.20; 1.04-1.39), and peak white blood cell count (OR=1.11; 1.02-1.21) were all associated with mortality among KTRs hospitalized for COVID-19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p<0.01). Conversely, immunosuppression intensity and degree of reduction following COVID-19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient-specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID-19.
Keywords: COVID-19; Immunosuppressive Agents; Kidney Transplantation; Transplant Recipients.
. 2021 Jan 9;e14221.
doi: 10.1111/ctr.14221. Online ahead of print.
Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus-2019 (COVID-19)
Andrew D Santeusanio[SUP] 1 [/SUP], Madhav C Menon[SUP] 1 [/SUP], Caroline Liu[SUP] 2 [/SUP], Arjun Bhansali[SUP] 1 [/SUP], Niralee Patel[SUP] 1 [/SUP], Fahima Mahir[SUP] 1 [/SUP], Meenakshi Rana[SUP] 3 [/SUP], Fasika Tedla[SUP] 1 [/SUP], Ahmad Mahamid[SUP] 1 [/SUP], Yaniv Fenig[SUP] 1 [/SUP], Alexey Zendel[SUP] 1 [/SUP], Veronica Delaney[SUP] 1 [/SUP], Graciela De Boccardo[SUP] 1 [/SUP], Samira S Farouk[SUP] 1 [/SUP], Vinita Sehgal[SUP] 1 [/SUP], Rafael Khaim[SUP] 1 [/SUP], Samantha E Jacobs[SUP] 3 [/SUP], Dallas Dunn[SUP] 3 [/SUP], Timothy Sullivan[SUP] 3 [/SUP], Sarah Taimur[SUP] 3 [/SUP], Emily Baneman[SUP] 3 [/SUP], Sander Florman[SUP] 1 [/SUP], Ron Shapiro[SUP] 1 [/SUP]
Affiliations
- PMID: 33421213
- DOI: 10.1111/ctr.14221
Abstract
The influence of patient characteristics and immunosuppression management on COVID-19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single-center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID-19 between 03/15/2020-05/15/2020. Patients were followed from the date of admission, up to 1-month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 mL/min/1.73m[SUP]2[/SUP] were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR=2.05; 1.04-4.04), peak D-dimer (OR=1.20; 1.04-1.39), and peak white blood cell count (OR=1.11; 1.02-1.21) were all associated with mortality among KTRs hospitalized for COVID-19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p<0.01). Conversely, immunosuppression intensity and degree of reduction following COVID-19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient-specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID-19.
Keywords: COVID-19; Immunosuppressive Agents; Kidney Transplantation; Transplant Recipients.