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Abstract: PO0787

COVID-19 Infection in Kidney Transplant Recipients: A Multicenter Experience in Istanbul

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Demir, Erol, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Uyar, Murathan, Yeni Yuzyil Universitesi, Istanbul, Turkey
  • Parmaks?z, Ergün, Dr Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
  • Sinangil, A., Istanbul Bilim Universitesi Tip Fakultesi, Istanbul, Turkey
  • Yelken, Berna, Koc Universitesi, Istanbul, Turkey
  • Dirim, Ahmet Burak, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Merhametsiz, Ozgur, Yeni Yuzyil Universitesi, Istanbul, Turkey
  • Yadigar, Serap, Dr Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
  • Atan ucar, Zuhal, Istanbul Bilim Universitesi Tip Fakultesi, Istanbul, Turkey
  • Ucar, A., Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Demir, Mehmet Emind, Yeni Yuzyil Universitesi, Istanbul, Turkey
  • Mese, M., Dr Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
  • Akin, Emin Baris, Istanbul Bilim Universitesi Tip Fakultesi, Istanbul, Turkey
  • Guller, Nurana, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Safak, Seda, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Oto, Ozgur Akin, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Yazici, Halil, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
  • Turkmen, Aydin, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Turkey
Background

Management of COVID-19 in kidney transplant recipients (KTR) should include treatment of infection and regulation of immunosuppression but there is no consensus on this issue yet. In this study, we aimed to describe our experience in KTR with COVID-19.

Methods

In this retrospective cohort study, we included KTR who diagnosed with COVID-19 from five centers. The patients were categorized into two groups for the analysis. Patients had respiratory failure and multiple organ dysfunctions were defined as severe pneumonia. All other cases were classified as moderate pneumonia. The primary endpoint was all-cause mortality.

Results

40 patients (20 female) were reviewed over a median follow-up of 32 days (IQR, 14-51 days) after COVID-19. 5 patients died during the follow-up. The frequency of graft dysfunction was similar between groups (n=12 and n=2; p=0.615, respectively). The frequency of previous induction (n=18 and n=7; p=0.016, respectively) and rejection therapy (n=4 and n=3; p=0.023, respectively) was significantly increased in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Also, multivariate logistic regression analysis revealed that previous anti-rejection therapy (9.75 [95% CI, 1.223 to 77.724; P=0.032]) was the independent predictor for mortality.

Conclusion

COVID-19 more commonly causes moderate or severe pneumonia in KTR. Immunosuppression should be carefully reduced in KTR. Induction therapy with lymphocyte depleting agents should be carefully avoided in KTR during the pandemic period.

The demographic characteristics, treatment regimen, and outcomes of the patients
  All patients
(n=40)
Moderate pneumonia
(n=33)
Severe pneumonia
(n=7)
p-value
 Age (Mean±SD, year)44.9±14.843.3±14.949.3±14.80.388
Type of Donor (N, %)Living
Deceased
35(87.5%)
5 (12.5%)
30 (90.9%)
3 (9.1%)
5 (71.4%)
2 (28.6%)
0.204
 Duration of Hospitalization
(Median-IQR 25-75, days)
9 (5-12)7 (4-12)13 (11-28)0.002
Laboratory results at admission
(Median-IQR 25-75)
Serum ALT levels
Serum LDH levels
16 (10-27)
257 (198-370)
15 (8-23)
249 (174-340)
27 (23-39)
559 (275-666)
0.015
0.048
Withdrawal of agent (N, %)Calcineurin inh.
Antimetabolites
11 (27%)
40 (100%)
7 (21.2%)
33 (100%)
4 (57.1%)
7 (100%)
0.075
1
Treatment of infection (N, %)Favipiravir18 (45%)12 (36.4%)6 (85.7%)0.024
Anti-cytokine agents (N, %)Tocilizumab
Anakinra
5 (12.5%)
3 (7.5%)
2 (6.1%)
3 (9.1%)
3 (42.9%)
0
0.024

Abbreviations; ALT, alanine aminotransferase; LDH, lactate dehydrogenase. P-values compared moderate pneumonia and severe pneumonia.