Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 1:35:10205.
doi: 10.3389/ti.2022.10205. eCollection 2022.

Temporal Reduction in COVID-19-Associated Fatality Among Kidney Transplant Recipients: The Brazilian COVID-19 Registry Cohort Study

Tainá Veras de Sandes-Freitas  1   2   3 , Marina Pontello Cristelli  4 , Lucio Roberto Requião-Moura  4   5   6 , Luís Gustavo Modelli de Andrade  7 , Laila Almeida Viana  4 , Valter Duro Garcia  8 , Claudia Maria Costa de Oliveira  2 , Ronaldo de Matos Esmeraldo  3 , Paula Roberta de Lima  1 , Ida Maria Maximina Fernandes Charpiot  9 , Teresa Cristina Alves Ferreira  10 , Rodrigo Fontanive Franco  11 , Kellen Micheline Alves Henrique Costa  12 , Denise Rodrigues Simão  13 , Gustavo Fernandes Ferreira  14 , Viviane Brandão Bandeira de Mello Santana  15 , Ricardo Augusto Monteiro de Barros Almeida  7 , Luciane Monica Deboni  16 , Anita Leme da Rocha Saldanha  17 , Irene de Lourdes Noronha  17   18 , Lívia Cláudio de Oliveira  19 , Deise De Boni Monteiro de Carvalho  20 , Reinaldo Barreto Oriá  1 , Jose Osmar Medina-Pestana  4   5 , Helio Tedesco-Silva Junior  4   5
Affiliations

Temporal Reduction in COVID-19-Associated Fatality Among Kidney Transplant Recipients: The Brazilian COVID-19 Registry Cohort Study

Tainá Veras de Sandes-Freitas et al. Transpl Int. .

Abstract

Data from the general population suggest that fatality rates declined during the course of the pandemic. This analysis, using data extracted from the Brazilian Kidney Transplant COVID-19 Registry, seeks to determine fatality rates over time since the index case on March 3rd, 2020. Data from hospitalized patients with RT-PCR positive SARS-CoV-2 infection from March to August 2020 (35 sites, 878 patients) were compared using trend tests according to quartiles (Q1: <72 days; Q2: 72-104 days; Q3: 105-140 days; Q4: >140 days after the index case). The 28-day fatality decreased from 29.5% (Q1) to 18.8% (Q4) (pfor-trend = 0.004). In multivariable analysis, patients diagnosed in Q4 showed a 35% reduced risk of death. The trend of reducing fatality was associated with a lower number of comorbidities (20.7-10.6%, p for-trend = 0.002), younger age (55-53 years, pfor-trend = 0.062), and better baseline renal function (43.6-47.7 ml/min/1.73 m2, pfor-trend = 0.060), and were confirmed by multivariable analysis. The proportion of patients presenting dyspnea (pfor-trend = 0.001) and hypoxemia (pfor-trend < 0.001) at diagnosis, and requiring intensive care was also found reduced (pfor-trend = 0.038). Despite possible confounding variables and time-dependent sampling differences, we conclude that COVID-19-associated fatality decreased over time. Differences in demographics, clinical presentation, and treatment options might be involved.

Keywords: Covid-19; Sars-CoV-2; coronavirus; kidney transplant; renal transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Distribution of COVID-19 diagnosed transplant patients after the index case, on March 3rd, 2020, according to quartiles.
FIGURE 2
FIGURE 2
Main signs and symptoms at COVID-19 diagnosis across the quartiles. Trend analyses were performed using Cochran–Armitage test and Jonckheere-Terpstra test.
FIGURE 3
FIGURE 3
Management of immunosuppressive drugs (A) and pharmacological treatments (B) across the quartiles. Legend: IS, immunosuppressive drugs; CNI, calcineurin inhibitor; ATB, antibiotics; AZI, azithromycin; ST, steroids. Trend analyses were performed using Cochran–Armitage test #Therapeutic-dose anticoagulants was empirically used for critically il patients with high d-dimer values, regardless of thrombosis events.
FIGURE 4
FIGURE 4
Cumulative incidence of deaths of SARS-CoV-2-infected kidney transplant patients within 28 days. (A) and 28-day fatality rates (B) across the quartiles.
FIGURE 5
FIGURE 5
Outcomes after SARS-CoV-2 infection in kidney transplant patients across the quartiles (A–C) and fatality rates (D). Legend: AKI, acute kidney injury; ICU, intensive care unit; MV, mechanical ventilation. Trend analyses were performed using Cochran–Armitage test.
See this image and copyright information in PMC

References

    1. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available at: https://covid19.who.int/ (Accessed March 28, 2021).
    1. Ranzani OT, Bastos LSL, Gelli JGM, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the First 250000 Hospital Admissions for COVID -19 in Brazil: A Retrospective Analysis of Nationwide Data. Lancet Respir Med (2021). 9(4):407–18. 10.1016/S2213-2600(20)30560-9 - DOI - PMC - PubMed
    1. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors Associated with COVID-19-Related Death Using OpenSAFELY. Nature (2020). 584(7821):430–6. 10.1038/s41586-020-2521-4 - DOI - PMC - PubMed
    1. Jouffroy R, Jost D, Prunet B. Prehospital Pulse Oximetry: a Red Flag for Early Detection of Silent Hypoxemia in COVID-19 Patients. Crit Care (2020). 24(1):313. 10.1186/s13054-020-03036-9 - DOI - PMC - PubMed
    1. Walker J, Dolly S, Ng L, Prior-Ong M, Sabapathy K. The Role of CPAP as a Potential Bridge to Invasive Ventilation and as a Ceiling-of-Care for Patients Hospitalized with Covid-19-An Observational Study. PLoS One (2020). 15(12):e0244857. 10.1371/journal.pone.0244857 - DOI - PMC - PubMed