Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus disease 2019 (COVID-19)

Andrew D. Santeusanio, Madhav C. Menon, Caroline Liu, Arjun Bhansali, Niralee Patel, Fahima Mahir, Meenakshi Rana, Fasika Tedla, Ahmad Mahamid, Yaniv Fenig, Alexey Zendel, Veronica Delaney, Graciela De Boccardo, Samira S. Farouk, Vinita Sehgal, Rafael Khaim, Samantha E. Jacobs, Dallas Dunn, Timothy Sullivan, Sarah TaimurEmily Baneman, Sander Florman, Ron Shapiro

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

The influence of patient characteristics and immunosuppression management on COVID-19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single-center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID-19 between 03/15/2020 and 05/15/2020. Patients were followed from the date of admission up to 1 month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 ml/min/1.73 m2 were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR = 2.05; 1.04-4.04), peak D-dimer (OR = 1.20; 1.04-1.39), and peak white blood cell count (OR = 1.11; 1.02-1.21) were all associated with mortality among KTRs hospitalized for COVID-19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p <.01). Conversely, immunosuppression intensity and degree of reduction following COVID-19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient-specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID-19.

Original languageEnglish
Article numbere14221
JournalClinical Transplantation
Volume35
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • COVID-19
  • immunosuppressive agents
  • kidney transplantation
  • transplant recipients

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