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. 2021 Mar;21(3):1285-1294.
doi: 10.1111/ajt.16416. Epub 2021 Jan 4.

COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities

Nathalie Chavarot  1   2 , Juliette Gueguen  2   3 , Guillaume Bonnet  2   3 , Mariam Jdidou  4 , Antonin Trimaille  5 , Carole Burger  1   2 , Lucile Amrouche  1 , Orianne Weizman  6 , Thibaut Pommier  7 , Olivier Aubert  2   3 , Joffrey Celier  8 , Rebecca Sberro-Soussan  1 , Laura Geneste  9 , Vassili Panagides  10 , Michel Delahousse  4 , Wassima Marsou  11 , Claire Aguilar  2   12 , Antoine Deney  13 , Julien Zuber  1   2 , Charles Fauvel  14 , Christophe Legendre  1   2 , Delphine Mika  15 , Theo Pezel  16 , Dany Anglicheau  1   2 , Willy Sutter  2   3 , Mohamad Zaidan  17 , Renaud Snanoudj  4 , Ariel Cohen  2   18 , Anne Scemla  1 ; Critical COVID-19 France Investigators
Affiliations

COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities

Nathalie Chavarot et al. Am J Transplant. 2021 Mar.

Abstract

Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3-73.1) in three French transplant centers. After a median follow-up of 13 days (7-30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2-14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.

Keywords: clinical research / practice; infection and infectious agents; infection and infectious agents - viral; kidney transplantation / nephrology.

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Figures

FIGURE 1
FIGURE 1
Loveplot for balance of covariances between KTRs and nontransplant patients before and after adjustment (A). The figure shows the standard median deviation (SMD) before (blue curve) and after (red curve) adjustment between cases and controls using a threshold = 0.1 for acceptable SMD. Propensity score distribution between matched and unmatched KTRs and matched and unmatched controls (B) [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Kaplan-Meier curves representing survival (A) and severe disease-free survival (B) in KTRs and in matched nontransplant patients [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Kaplan-Meier curves representing survival (A) and severe disease-free survival (B) in matched KTRs, in matched nontransplant patients, in unmatched KTRs, and in unmatched nontransplant patients
See this image and copyright information in PMC

Comment in

  • Long-term effects of COVID-19 in solid organ transplantation recipients.
    Larrosa-Garcia M, Garcia-Garcia S, Los-Arcos I, Moreso F, Berastegui C, Castells L, Gorgas Torner MQ, Miarons M. Larrosa-Garcia M, et al. Transpl Infect Dis. 2021 Aug;23(4):e13677. doi: 10.1111/tid.13677. Epub 2021 Jul 12. Transpl Infect Dis. 2021. PMID: 34174006 Free PMC article. No abstract available.

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