tetano
Editor, Senior Moderator
Rom J Intern Med
. 2020 Nov 5;/j/rjim.ahead-of-print/rjim-2020-0034/rjim-2020-0034.xml.
doi: 10.2478/rjim-2020-0034. Online ahead of print.
Predictors of disease severity and outcome of hospitalized renal transplant recipients with COVID-19 infection: A systematic review of a globally representative sample
Irtiza Hasan[SUP] 1 2 [/SUP], Tasnuva Rashid[SUP] 3 [/SUP], Sarah Suliman[SUP] 2 [/SUP], Hatem Amer[SUP] 4 [/SUP], Razvan M Chirila[SUP] 5 [/SUP], Martin L Mai[SUP] 2 [/SUP], Tambi Jarmi[SUP] 2 [/SUP], Samir Khouzam[SUP] 2 [/SUP], Pablo Moreno Franco[SUP] 2 [/SUP], Charles W Heilig[SUP] 1 [/SUP], Hani M Wadei[SUP] 2 [/SUP]
Affiliations
Abstract
Introduction: COVID-19 presents a special challenge to the kidney transplant population.
Methods: A systematic review of articles that examined COVID-19 in kidney transplant recipients was performed. Patients' demographics, clinical, laboratory and radiological presentations, immunosuppression modification, and COVID-19 specific management were abstracted and analyzed. COVID-19 severity was classified into mild, moderate, and severe. Disease outcome was classified by whether the patient was discharged, still hospitalized, or died.
Results: 44 articles reporting individual data and 13 articles reporting aggregated data on 149 and 561 kidney transplant recipients respectively with COVID-19 from Asia, Europe and America fulfilled all inclusion and exclusion criteria. Among studies reporting case specific data, 76% of cases had severe disease. Compared to patients with mild/moderate disease, patients with severe disease had higher CRP, LDH, Ferritin, D-dimer and were more likely to have bilateral lung involvement at presentation and longer time since transplantation (P<0.05 for all). Recipients' age, gender and comorbidities did not impact disease severity. Patients with severe disease had a more aggressive CNI reduction and more antiviral medications utilization. Outcome was reported on 145 cases, of those 34 (23%) died all with severe disease. Longer duration from transplant to disease diagnosis, hypoxia and higher LDH were associated with mortality (P<0.05). Different immunosuppression reduction strategies, high dose parenteral corticosteroids use and various antiviral combinations did not demonstrate survival advantage. Similar finding was observed for studies reporting aggregated data.
Conclusion: COVID-19 in kidney transplant patients is associated with high rate of disease severity and fatality. Higher LDH and longer time since transplantation predicted both disease severity and mortality. None of the COVID-19 specific treatment correlated with, or improved disease outcome in kidney transplant recipients.
Keywords: COVID-19; Coronavirus disease 2019; Coronavirus pandemic; Immunosuppression; Novel coronavirus; Renal transplant; SARS-CoV-2; Severe Acute Respiratory Syndrome Coronavirus 2; Transplant recipient.
. 2020 Nov 5;/j/rjim.ahead-of-print/rjim-2020-0034/rjim-2020-0034.xml.
doi: 10.2478/rjim-2020-0034. Online ahead of print.
Predictors of disease severity and outcome of hospitalized renal transplant recipients with COVID-19 infection: A systematic review of a globally representative sample
Irtiza Hasan[SUP] 1 2 [/SUP], Tasnuva Rashid[SUP] 3 [/SUP], Sarah Suliman[SUP] 2 [/SUP], Hatem Amer[SUP] 4 [/SUP], Razvan M Chirila[SUP] 5 [/SUP], Martin L Mai[SUP] 2 [/SUP], Tambi Jarmi[SUP] 2 [/SUP], Samir Khouzam[SUP] 2 [/SUP], Pablo Moreno Franco[SUP] 2 [/SUP], Charles W Heilig[SUP] 1 [/SUP], Hani M Wadei[SUP] 2 [/SUP]
Affiliations
- PMID: 33155999
- DOI: 10.2478/rjim-2020-0034
Abstract
Introduction: COVID-19 presents a special challenge to the kidney transplant population.
Methods: A systematic review of articles that examined COVID-19 in kidney transplant recipients was performed. Patients' demographics, clinical, laboratory and radiological presentations, immunosuppression modification, and COVID-19 specific management were abstracted and analyzed. COVID-19 severity was classified into mild, moderate, and severe. Disease outcome was classified by whether the patient was discharged, still hospitalized, or died.
Results: 44 articles reporting individual data and 13 articles reporting aggregated data on 149 and 561 kidney transplant recipients respectively with COVID-19 from Asia, Europe and America fulfilled all inclusion and exclusion criteria. Among studies reporting case specific data, 76% of cases had severe disease. Compared to patients with mild/moderate disease, patients with severe disease had higher CRP, LDH, Ferritin, D-dimer and were more likely to have bilateral lung involvement at presentation and longer time since transplantation (P<0.05 for all). Recipients' age, gender and comorbidities did not impact disease severity. Patients with severe disease had a more aggressive CNI reduction and more antiviral medications utilization. Outcome was reported on 145 cases, of those 34 (23%) died all with severe disease. Longer duration from transplant to disease diagnosis, hypoxia and higher LDH were associated with mortality (P<0.05). Different immunosuppression reduction strategies, high dose parenteral corticosteroids use and various antiviral combinations did not demonstrate survival advantage. Similar finding was observed for studies reporting aggregated data.
Conclusion: COVID-19 in kidney transplant patients is associated with high rate of disease severity and fatality. Higher LDH and longer time since transplantation predicted both disease severity and mortality. None of the COVID-19 specific treatment correlated with, or improved disease outcome in kidney transplant recipients.
Keywords: COVID-19; Coronavirus disease 2019; Coronavirus pandemic; Immunosuppression; Novel coronavirus; Renal transplant; SARS-CoV-2; Severe Acute Respiratory Syndrome Coronavirus 2; Transplant recipient.