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. 2021 Jan 1;105(1):170-176.
doi: 10.1097/TP.0000000000003502.

Early Changes in Kidney Transplant Immunosuppression Regimens During the COVID-19 Pandemic

Sunjae Bae  1   2 , Mara A McAdams-DeMarco  1   2 , Allan B Massie  1   2 , JiYoon B Ahn  1 , William A Werbel  3 , Daniel C Brennan  3 , Krista L Lentine  4 , Christine M Durand  3   5 , Dorry L Segev  1   2
Affiliations

Early Changes in Kidney Transplant Immunosuppression Regimens During the COVID-19 Pandemic

Sunjae Bae et al. Transplantation. .

Abstract

Background: Kidney transplant recipients have higher risk of infectious diseases due to their reliance on immunosuppression. During the current COVID-19 pandemic, some clinicians might have opted for less potent immunosuppressive agents to counterbalance the novel infectious risk. We conducted a nationwide study to characterize immunosuppression use and subsequent clinical outcomes during the first 5 months of COVID-19 pandemic in the United States.

Methods: Using data from the Scientific Registry of Transplant Recipients, we studied all kidney-only recipients in the United States from January 1, 2017, to March 12, 2020 ("prepandemic" era; n = 64 849) and from March 13, 2020, to July 31, 2020 ("pandemic" era; n = 5035). We compared the use of lymphocyte-depleting agents (versus basiliximab or no induction) and maintenance steroids (versus steroid avoidance/withdrawal) in the pandemic era compared with the prepandemic era. Then, we compared early posttransplant outcomes by immunosuppression regimen during the pandemic era.

Results: Recipients in the pandemic era were substantially less likely to receive lymphocyte-depleting induction agents compared with their prepandemic counterparts (aOR = 0.400.530.69); similar trends were found across subgroups of state-level COVID-19 incidence, donor type, and recipient age. However, lymphocyte-depleting induction agents were associated with decreased rejection during admission (aOR = 0.110.230.47) but not with increased mortality in the pandemic era (aHR = 0.130.471.66). On the other hand, the use of maintenance steroids versus early steroid withdrawal remained similar (aOR = 0.711.071.62).

Conclusions: The use of lymphocyte-depleting induction agents has decreased in favor of basiliximab and no induction during the COVID-19 pandemic. However, this shift might have resulted in increases in rejection with no clear reductions in posttransplant mortality.

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Conflict of interest statement

D.L.S. receives speaking honoraria from Sanofi, Novartis, and CSL Behring. All other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.. Estimated probability of using lymphocyte-depleting agents and maintenance steroids in the prepandemic versus pandemic era among the pandemic era recipients.
(a) Lymphocyte-depleting agents (vs. nondepleting agent or no induction). (b) Maintenance steroids (vs. early steroid withdrawal).
Figure 1.
Figure 1.. Estimated probability of using lymphocyte-depleting agents and maintenance steroids in the prepandemic versus pandemic era among the pandemic era recipients.
(a) Lymphocyte-depleting agents (vs. nondepleting agent or no induction). (b) Maintenance steroids (vs. early steroid withdrawal).
Figure 2.
Figure 2.. Changes in the use of lymphocyte-depleting agents and maintenance steroids during the COVID-19 pandemic; subgroup analyses.
(a) Lymphocyte-depleting agents (vs. nondepleting agent or no induction). (b) Maintenance steroids (vs. early steroid withdrawal).
Figure 2.
Figure 2.. Changes in the use of lymphocyte-depleting agents and maintenance steroids during the COVID-19 pandemic; subgroup analyses.
(a) Lymphocyte-depleting agents (vs. nondepleting agent or no induction). (b) Maintenance steroids (vs. early steroid withdrawal).
See this image and copyright information in PMC

Comment in

References

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