tetano
Editor, Senior Moderator
Transplantation
. 2020 Dec 21;Publish Ahead of Print.
doi: 10.1097/TP.0000000000003593. Online ahead of print.
Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: a Multicenter Cohort Study From India
Vivek B Kute[SUP] 1 [/SUP], Anil K Bhalla, Sandeep Guleria, Deepak S Ray, Madan M Bahadur, Ashay Shingare, Umapati Hegade, Sishir Gang, Sreebhushan Raju, Himanshu V Patel, Siddharth Jain, Suraj Godara, Pranjal Modi, Manoj Gumber, Divyesh P Engineer, Sonal Dalal, Prakash Darji, Manish Balwani, Ansy H Patel, Vineet V Mishra
Affiliations
Abstract
Background: There is scarcity of data on the consequences coronavirus 19 (COVID-19) infections in kidney transplant recipients (KTR) from emerging countries.
Methods: Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donor) with PCR confirmed COVID-19 positivity from March 23, 2020 until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment and outcomes.
Results: Median age of transplant recipients was 43 years and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%), diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%) and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age, dyspnoea, severe disease, obesity, allograft dysfunction prior to COVID-19 infection, acute kidney injury (AKI) , higher levels of inflammatory markers including C reactive protein, IL6 level, procalcitonin, chest XR abnormality, and ICU/ventilator requirements. Overall patient mortality was 11.6%(29/250), 14.5%(29/200) in hospitalized patients, 47%(25/53) in ICU patients and 96.7%(29/30) in patients requiring ventilation. KTR with mild COVID-19 symptoms(n=50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic.
Conclusions: Mortality rates in COVID-19 positive KTR appears to be higher than those in nonimmunosuppressed patients and high mortality was noted among those requiring intensive care and those on ventilator.
. 2020 Dec 21;Publish Ahead of Print.
doi: 10.1097/TP.0000000000003593. Online ahead of print.
Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: a Multicenter Cohort Study From India
Vivek B Kute[SUP] 1 [/SUP], Anil K Bhalla, Sandeep Guleria, Deepak S Ray, Madan M Bahadur, Ashay Shingare, Umapati Hegade, Sishir Gang, Sreebhushan Raju, Himanshu V Patel, Siddharth Jain, Suraj Godara, Pranjal Modi, Manoj Gumber, Divyesh P Engineer, Sonal Dalal, Prakash Darji, Manish Balwani, Ansy H Patel, Vineet V Mishra
Affiliations
- PMID: 33350674
- DOI: 10.1097/TP.0000000000003593
Abstract
Background: There is scarcity of data on the consequences coronavirus 19 (COVID-19) infections in kidney transplant recipients (KTR) from emerging countries.
Methods: Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donor) with PCR confirmed COVID-19 positivity from March 23, 2020 until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment and outcomes.
Results: Median age of transplant recipients was 43 years and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%), diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%) and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age, dyspnoea, severe disease, obesity, allograft dysfunction prior to COVID-19 infection, acute kidney injury (AKI) , higher levels of inflammatory markers including C reactive protein, IL6 level, procalcitonin, chest XR abnormality, and ICU/ventilator requirements. Overall patient mortality was 11.6%(29/250), 14.5%(29/200) in hospitalized patients, 47%(25/53) in ICU patients and 96.7%(29/30) in patients requiring ventilation. KTR with mild COVID-19 symptoms(n=50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic.
Conclusions: Mortality rates in COVID-19 positive KTR appears to be higher than those in nonimmunosuppressed patients and high mortality was noted among those requiring intensive care and those on ventilator.