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Abstract: TH-PO960

Opportunistic Infections in Post Renal Transplant Patients Treated With Dexamethasone for COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Morrison, Benjamin G., University of Kentucky, Lexington, Kentucky, United States
  • Fattah, Hasan, University of Kentucky, Lexington, Kentucky, United States
Background

Dexamethasone, a common treatment regimen for COVID-19, may mitigate inflammation-mediated lung injury in immunocompromised patients who have COVID-19 with severe disease. However, it comes with the cost of further suppressing the immune system, increasing the risk for opportunistic infections. This study looked at various post renal transplant patients on immunosuppression who contracted COVID-19, their treatment with or without dexamethasone, and their subsequent development of opportunistic infections that necessitated readmission.

Methods

We identified index hospitalization for COVID-19 amongst kidney transplant recipients between 2020 and 2022 at our institution. Local electronic medical record review was utilized for demographics, vaccination status, readmissions for opportunistic infections, and dexamethasone treatment characteristics for COVID-19 infection.

Results

Of the 33 patients included in the analyses, 14 (42.4%) were readmitted at least once for opportunistic infections. Those readmissions included 5 cases of viral infection, 14 bacterial infection, and 4 fungal infection. For treatment of COVID-19, 18/33 patients (54.5%) received at least 1 dose of dexamethasone. Of the 18 patients given dexamethasone, 8 (44.4%) were found to be among the 14 readmitted patients with opportunistic infection. Of the 33 patients, 25 (75.8%) had received at least one dose of the COVID-19 vaccine at the time of COVID-19 diagnosis. Amongst the 14 readmitted patients, 8 (57.1%) had received at least one dose of COVID-19 vaccine at time of COVID diagnosis and 6 (42.9%) had not received any vaccine.

Conclusion

In this single cohort, readmission rate after COVID-19 hospitalization for kidney transplant recipient was 42%, higher than the average rate for all COVID-19 cases readmission rate (12% per CDC, 27% per National Veterans Affairs). Glucocorticoid use should be done with extreme caution in immunocompromised patients due to the increased risk for opportunistic infections. Opportunistic infections were associated with corticosteroids use in 44% of COVID-19 patients in this group. Another risk factor for opportunistic infection following COVID-19 in immunosuppressed patients may be vaccination status at the time of COVID-19 diagnosis.