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COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities

https://doi.org/10.1111/ajt.16416Get rights and content
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Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3–73.1) in three French transplant centers. After a median follow-up of 13 days (7–30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2–14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.

KEYWORDS

clinical research / practice
infection and infectious agents
infection and infectious agents - viral
kidney transplantation / nephrology

Abbreviations

ATG
antithymocyte globulin
BMI
body mass index
COVID-19
coronavirus disease 2019
CRP
C-reactive protein
CT
chest-computed tomography
eGFR
estimated glomerular filtration rate
FiO2
Fraction of inspired oxygen
HR
hazard ratio
ICU
intensive care unit
IL
interleukin
IQRs
interquartile ranges
KT
kidney transplantation
LDH
lactic acid dehydrogenase
MPA
mycophenolic acid
MV
mechanical ventilation
RT-PCR
reverse transcriptase-polymerase chain reaction

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A complete list of the Critical COVID-19 France Investigators is provided in the Supplementary Appendix.

Drs Chavarot and Gueguen contributed equally to this article.