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Kidney Week

Abstract: PO0788

COVID-19 and Kidney Transplant Outcomes

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

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

Recent publications report great variations in the clinical course and mortality of COVID-19 in solid organ transplant (SOT) recipients. It is unclear whether these differences are related to study methods, treatment choices, or variables associated with patient populations.

Methods

We reviewed and summarized 9 published articles of COVID-19 in solid organ transplant recipients. We contrasted difference between study design and compared outcomes.

Results

All studies included kidney transplant recipients while study 6 and 8 included non-renal SOT. Four come from the United States. Results can be seen in the attached table. Most studies had a median age in the 50’s, with hypertension and diabetes being common comorbidities. Tacrolimus, mycophenolate analogs and prednisone was the most common immunosuppression regimen. Presenting symptoms were usually fever, cough, dyspnea, and diarrhea. Immunosuppression was either reduced or discontinued in all studies.
The majority of patients received hydroxychloroquine. Azithromycin, remdesevir, leronlimab, lopinavir/ritonavir, darunavir, oseltamivir, and tocilizumab were also used. Mortality ranged from 0% to 30%. All studies described hospitalized patients. A third of reports also included outpatients. The median follow up was approximately 3 weeks for most studies (range of 7 to 29 days).
All but one series with reported patient deaths under 20% either did not include or had follow-up periods of less than 10 days.

Conclusion

Presentation of COVID-19 and immunosuppression strategies are similar among transplant centers. Differing outcomes may be related to small number of cases, potentially varying acuities of illness and follow up periods. Given that cytokine storm occurs late in the course of COVID-19, it is plausible that mortality may increase in studies with short follow up. When excluding short or missing follow up, mortality appears to be between 20-30%, which suggests that transplant recipients have a higher mortality than their non-immunocompromised peers.