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Kidney Week

Abstract: TH-PO863

Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Among Kidney Transplant Recipients: A Large Single-Center Experience

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Zona, Emily E., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Gibes, Mina Lor, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Jain, Asha S., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Danobeitia, Juan S., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Garonzik Wang, Jacqueline, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Kidney transplant recipients (KTR) are a vulnerable immunocompromised population at risk of severe disease and mortality from COVID-19. We characterized the sequelae of infection in KTRs at our center.

Methods

We studied all adult KTRs who had their first episode of COVID-19 between 04/2020 and 04/2022 and at least 12 months of follow-up (unless graft failure or death). Outcomes of interest included risk factors for hospitalization, all-cause mortality, and COVID-19-related mortality.

Results

Of 979 KTRs, 381 (39%) were hospitalized due to their first episode of COVID-19.
There were some differences in baseline characteristics: those hospitalized had advanced age at COVID-19 diagnosis (59.8 (12.9) vs. 53.7 (12.6), p<0.001), were more likely to be male (63% vs. 55%, p=0.02), non-white (28% vs. 16%, p<0.001), have diabetes mellitus as a cause of ESKD (33% vs. 14%, p<0.001), and less likely to be living donor recipients (35% vs. 48%, p<0.001).
In multivariate analysis, risk factors for hospitalization included advanced age at COVID diagnosis (HR: 1.03, 95%CI: 1.02-1.04), male recipient (HR: 1.29, 95%CI: 1.04-1.60), nonwhite recipient (HR: 1.48, 95%CI: 1.17-1.88), and diabetes as a cause of ESRD (HR: 1.77, 95%CI: 1.41-2.21). Vaccination against COVID-19 protected against risk of hospitalization (HR: 0.73, 95%CI: 0.59-0.90), risk for all-cause mortality (HR: 0.52, 95%CI: 0.37-0.74), and risk for COVID-related mortality (HR: 0.47, 95%CI: 0.31-0.71).
Risk factors for both all-cause and COVID-related mortality in the multivariate analyses included advanced age (HR: 1.05, 95%CI: 1.03-1.07; HR: 1.04, 95%CI: 1.02-1.05), hospitalization (HR: 6.76, 95%CI: 3.43-13.28; HR: 24.3, 95%CI: 6.9-85.7), and respiratory symptoms for hospital admission (HR: 2.29, 95%CI: 1.42-3.68; HR: 2.73, 95%CI: 1.52-4.89). Furthermore, additional risk factors for all-cause mortality in multivariate analysis included being a nonwhite recipient (HR: 1.46, 95%CI: 1.01-2.12) and diabetes as a cause of ESKD (HR: 1.42, 95%CI: 1.0-2.01), with being a recipient of a living donor as protective (HR: 0.69, 95%CI: 0.48-1.0).

Conclusion

Hospitalization due to COVID-19 is associated with increased mortality. Vaccination against COVID-19 is a protective factor against hospitalization and mortality.