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. 2025 Apr 18;25(1):560.
doi: 10.1186/s12879-025-10994-4.

Risk factors for mortality among kidney transplant recipients with COVID-19 in Saudi Arabia: a case-control study

Dema A Alissa  1   2   3 , Rawan Almasuood  4 , Baraa Alghalyini  5 , Hala Tamim  5   6 , Mohammed Alaa Raslan  7 , Abdul Rehman Zia Zaidi  5 , Bader Abou Shaar  5 , Mhd Malek Al Masri  7 , Adnan Abdul Karim  7 , Wejdan Aburas  4 , Waled Aburas  8 , Ahmed H Al-Jedai  4   7 , Reem S Almaghrabi  9
Affiliations

Risk factors for mortality among kidney transplant recipients with COVID-19 in Saudi Arabia: a case-control study

Dema A Alissa et al. BMC Infect Dis. .

Abstract

Background: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has profoundly impacted global health, leading to over 74 million confirmed cases and 1.67 million deaths by December 2020. In Saudi Arabia, extensive measures were implemented to mitigate the spread of the virus. Kidney transplant recipients, due to their immunosuppressed status, are particularly vulnerable to severe COVID-19 outcomes. This study aims to identify risk factors associated with mortality in COVID-19-infected kidney transplant patients in Saudi Arabia. The primary objective is to identify mortality risk factors among COVID-19-infected kidney transplant patients. The secondary objective is to compare clinical management and outcomes between deceased and recovered patients.

Methodology: This case-control study matched 82 deceased kidney transplant patients (cases) with 151 survivors (controls). Data were collected from the National Registry for COVID-19 Mortality and King Faisal Specialist Hospital and Research Centre (KFSH&RC) for patients diagnosed between March 2020 and January 2021. Key variables included demographic information, comorbidities, clinical symptoms, and treatment details. Statistical analyses involved chi-square tests and multivariable logistic regression to assess associations with mortality.

Results: Among cases, 93.9% required ICU admission, and 95.1% were intubated. Males constituted 73.2% of cases, with 53.7% aged over 60. Cardiovascular comorbidities were more prevalent among cases (97% vs. 87.4%, p = 0.01). and presented more frequently with fever, cough, and respiratory distress. In multivariable analysis, fever, shortness of breath, and desaturation were associated with increased mortality odds. Notably, patients who discontinued immunosuppressive therapy had higher mortality odds (OR = 63.2, p = 0.083), whereas those who held or adjusted their therapy had significantly lower odds (OR = 0.1, p = 0.042; OR = 0.0, p = 0.007). Bacterial infections also increased mortality risk (OR = 56.6, p = 0.009).

Conclusion: This study identifies critical risk factors for mortality among kidney transplant patients infected with COVID-19 in Saudi Arabia. The findings underscore the need for tailored clinical management strategies to improve outcomes in this vulnerable population. Further research is warranted to explore long-term implications and effective treatment protocols.

Keywords: COVID-19; Kidney transplant recipients; Mortality; Risk factors; Saudi Arabia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in accordance with the policies and procedures of the ethics committee at the Ministry of Health (MOH) and King Faisal Specialist Hospital and Research Center (KFSHRC), which follows the Declaration of Helsinki. The study was approved by the central IRB of the MOH (log No: 21–24 M) and KFSHRC (log No:2221015). The IRB did not require informed consent as this was not an interventional study. The need for informed consent was waived by the ethics committee at (MOH and KFSHRC. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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