Am J Transplant. 2020 Jul 10. doi: 10.1111/ajt.16185. Link
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Paolo Cravedi1, Suraj Sarvode Mothi2, Yorg Azzi3, Meredith Haverly1, Samira Farouk4, María José Pérez-Sáez5, Maria Dolores Redondo-Pachón5, Barbara Murphy1, Sander Florman4, Laura Goldfarb Cyrino2, Monica Grafals6, Sandheep Venkataraman6, Xingxing Shelley Cheng7, Aileen Xinqian Wang7, Gianluigi Zaza8, Andrea Ranghino9, Lucrezia Furian10, Joaquin Manrique11, Umberto Maggiore11, Ilaria Gandolfini12, Nikhil Agrawal13, Het Patel13, Enver Akalin3, Leonardo V. Riella2 for the TANGO study group
Abstract
Kidney transplant recipients may be at high risk of developing critical COVID-19 illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the US, Italy and Spain who tested positive for COVID-19. Clinical presentation, laboratory values, immunosuppression and treatment strategies were reviewed and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9,845 kidney transplant recipients across centers, 144 were hospitalized due to COVID-19 during the 9-week study period. 65% were male with a mean age of 60 (±12) years, 40% Hispanic and 25% African-American. Prevalent comorbidities included hypertension (95%), diabetes (52%), obesity (49%), heart (28%) and lung (19%) disease. Therapeutic management included antimetabolite withdrawal (68%), calcineurin inhibitor withdrawal (23%), hydroxychloroquine (71%), antibiotics (74%), tocilizumab (13%) and antivirals (14%). During a median follow-up period of 52 days (IQR: 16-66 days), acute kidney injury occurred in 52% cases, respiratory failure requiring intubation in 29%, and mortality was 32%. The 44 patients who died were older, had lower lymphocyte counts and eGFR, higher serum lactate dehydrogenase, procalcitonin and IL-6 levels. In sum, hospitalized kidney transplant recipients with COVID-19 have higher rates of acute kidney injury and mortality.