Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study

Abstract

Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.

Keywords: clinical research/practice; complication: infectious; epidemiology; infectious disease; kidney transplantation/nephrology; patient survival.

FIGURE 1

Flowchart of the study population. We excluded nonhospitalized and nonconfirmed by real-time RT-PCR COVID-19 kidney recipients. ED, emergency department

FIGURE 2

Clinical presentation of coronavirus disease 2019 pneumonia. Figure shows proportion of pulmonary and extrapulmonary manifestations at admission. ARDS, acute respiratory distress syndrome [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Dynamic profile of laboratory markers in kidney transplant recipients with COVID-19. Differences between survivors and non survivors are shown; significant differences are indicated. Box below each graph detail the number of patient at risk and/or availability of the test. CRP, C-reactive protein [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

A, Proportion of antiviral therapies use and associated adverse effects. Distribution among survivors and nonsurvivors is shown. B, Associated adverse effects. AR, acute graft rejection; CNI, calcineurin inhibitor; DRV/r, darunavir/ritonavir; DRV/COBI, darunavir/cobicistat; GI, gastrointestinal; HCQ, hydroxychloroquine; IFN-β, interferon-beta; LPV/r, lopinavir/ritonavir; TOCI, tocilizumab [Color figure can be viewed at wileyonlinelibrary.com]