tetano
Editor, Senior Moderator
EClinicalMedicine
. 2022 Mar 25;101359.
doi: 10.1016/j.eclinm.2022.101359. Online ahead of print.
Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study
Vivek B Kute[SUP] 1 [/SUP], Deepak S Ray[SUP] 2 [/SUP], Feroz Aziz[SUP] 3 [/SUP], Suraj M Godara[SUP] 4 [/SUP], Umapati Hegde[SUP] 5 [/SUP], Anil KumarBT[SUP] 6 [/SUP], Anil K Bhalla[SUP] 7 [/SUP], Dinesh Kumar Yadav[SUP] 8 [/SUP], Sarbpreet Singh[SUP] 9 [/SUP], Vivek Pathak[SUP] 10 [/SUP], Sonal Dalal[SUP] 11 [/SUP], Madan M Bahadur[SUP] 12 [/SUP], Urmila Anandh[SUP] 13 [/SUP], Abi Abraham M[SUP] 14 [/SUP], Vishwanath Siddini[SUP] 15 [/SUP], Sushree Sashmita Das[SUP] 2 [/SUP], Sharmila Thukral[SUP] 2 [/SUP], Arvind Krishnakumar[SUP] 3 [/SUP], Ashish Sharma[SUP] 9 [/SUP], Vijay Kher[SUP] 8 [/SUP], Shyam B Bansal[SUP] 8 [/SUP], Ashay Shingare[SUP] 12 [/SUP], Ranjit Narayanan[SUP] 3 [/SUP], Himanshu Patel[SUP] 1 [/SUP], Sanjeev Gulati[SUP] 16 [/SUP], Shailesh Kakde[SUP] 17 [/SUP], Dinesh Bansal[SUP] 8 [/SUP], Sandeep Guleria[SUP] 18 [/SUP], Dinesh Khullar[SUP] 19 [/SUP], Manoj R Gumber[SUP] 20 [/SUP], Umesh Varyani[SUP] 21 [/SUP], Swarnalatha Guditi[SUP] 22 [/SUP], Prakash Khetan[SUP] 23 [/SUP], Rutul Dave[SUP] 11 [/SUP], Vineet V Mishra[SUP] 1 [/SUP], Stefan G Tullius[SUP] 24 [/SUP], Sanshriti Chauhan[SUP] 1 [/SUP], Hari Shankar Meshram[SUP] 1 [/SUP]
Affiliations
Abstract
Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19).
Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up.
Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity.
Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19.
Funding: Sanofi.
Keywords: Induction immunosuppression; Kidney transplantation; Post-COVID-19; SARS-CoV-2.
. 2022 Mar 25;101359.
doi: 10.1016/j.eclinm.2022.101359. Online ahead of print.
Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study
Vivek B Kute[SUP] 1 [/SUP], Deepak S Ray[SUP] 2 [/SUP], Feroz Aziz[SUP] 3 [/SUP], Suraj M Godara[SUP] 4 [/SUP], Umapati Hegde[SUP] 5 [/SUP], Anil KumarBT[SUP] 6 [/SUP], Anil K Bhalla[SUP] 7 [/SUP], Dinesh Kumar Yadav[SUP] 8 [/SUP], Sarbpreet Singh[SUP] 9 [/SUP], Vivek Pathak[SUP] 10 [/SUP], Sonal Dalal[SUP] 11 [/SUP], Madan M Bahadur[SUP] 12 [/SUP], Urmila Anandh[SUP] 13 [/SUP], Abi Abraham M[SUP] 14 [/SUP], Vishwanath Siddini[SUP] 15 [/SUP], Sushree Sashmita Das[SUP] 2 [/SUP], Sharmila Thukral[SUP] 2 [/SUP], Arvind Krishnakumar[SUP] 3 [/SUP], Ashish Sharma[SUP] 9 [/SUP], Vijay Kher[SUP] 8 [/SUP], Shyam B Bansal[SUP] 8 [/SUP], Ashay Shingare[SUP] 12 [/SUP], Ranjit Narayanan[SUP] 3 [/SUP], Himanshu Patel[SUP] 1 [/SUP], Sanjeev Gulati[SUP] 16 [/SUP], Shailesh Kakde[SUP] 17 [/SUP], Dinesh Bansal[SUP] 8 [/SUP], Sandeep Guleria[SUP] 18 [/SUP], Dinesh Khullar[SUP] 19 [/SUP], Manoj R Gumber[SUP] 20 [/SUP], Umesh Varyani[SUP] 21 [/SUP], Swarnalatha Guditi[SUP] 22 [/SUP], Prakash Khetan[SUP] 23 [/SUP], Rutul Dave[SUP] 11 [/SUP], Vineet V Mishra[SUP] 1 [/SUP], Stefan G Tullius[SUP] 24 [/SUP], Sanshriti Chauhan[SUP] 1 [/SUP], Hari Shankar Meshram[SUP] 1 [/SUP]
Affiliations
- PMID: 35350707
- PMCID: PMC8948372
- DOI: 10.1016/j.eclinm.2022.101359
Abstract
Background: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19).
Methods: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up.
Findings: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity.
Interpretation: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19.
Funding: Sanofi.
Keywords: Induction immunosuppression; Kidney transplantation; Post-COVID-19; SARS-CoV-2.