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Kidney Week

Abstract: PO0768

Risk Factors for Mortality in Kidney Transplant Recipients with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Nair, Vinay, Northwell Health, Great Neck, New York, United States
  • Jandovitz, Nicholas, Northwell Health, Great Neck, New York, United States
  • Abate, Mersema, Northwell Health, Great Neck, New York, United States
  • Nair, Gayatri Devi, Northwell Health, Great Neck, New York, United States
  • Bhaskaran, Madhu C., Northwell Health, Great Neck, New York, United States
  • Molmenti, Ernesto P., Northwell Health, Great Neck, New York, United States
Background

There is limited information on the presentation and risk factors for poor outcome in kidney transplant recipients with COVID-19.

Methods

We reviewed data of admitted kidney transplant recipients at 12 system hospitals with COVID-19 between March 1, 2020, and April 30th, 2020. We analyzed risk factors for mortality.

Results

31 patients were identified, 30 were admitted. Median age was 58 (IQR 53-68), 61% male, 32% Caucasian, 29% African American, 29% multiracial and 6% Asian. Median time from transplant to COVID-19 testing was 1178 days (IQR 252-2897). The most common symptom was cough, followed by fever, shortness of breath and fatigue. Chest X-ray/CT revealed multifocal patchy opacities. Ten patients required mechanical ventilation. Laboratory markers can be seen in the table. Acute kidney injury occurred in 39% of patients. The majority of patients were on triple immunosuppression (94% on tacrolimus, 90% on mycophenolate, and 74% on prednisone). During the hospital course 87% had the antimetabolite stopped while 35% had CNI stopped. Treatments utilized included hydroxychloroquine (93%), azithromycin (50%), convalescent plasma (14%), IL-6 inhibitor (10%) and 1 received remdesivir. At a median follow up of 19 days (IQR 8 – 26) 10 patients died. Risk of death was greater if the patient was admitted to a non-transplant hospital (80% vs 23%, p=0.027), lymphopenic at presentation (47% vs 8%, p=0.013 or had O2 saturation less than 94% upon admission (100% vs 57%, p=0.03). During hospitalization mortality was also higher in patients with higher peak serum creatinine (3.2 mg/dl vs 1.5 mg/dl, p=0.013), or if requiring intubated (70% vs 14%, p<0.001). Increase in inflammatory markers including peak D-dimer, peak CRP, ferritin and procalcitonin were also predictive of mortality.

Conclusion

Kidney transplant recipients with COVID-19 should be monitored closely in a transplant center. Mortality is high, particularly in patients presenting with lymphopenia and hypoxemia.

All data presented in median (IQR) unless otherwise noted