Clinical characteristics and outcomes of COVID-19 in kidney transplant recipients

R. O. Kantariya, Y. Moysyuk, E. Prokopenko, A. R. Karapityan, A. Ammosov, A. Makevnina, A. Gaydarova
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引用次数: 2

Abstract

Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p<0.00001) and 21.5 (p<0.0006) times higher risk of death, respectively.Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p<0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.><0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.
肾移植受者COVID-19的临床特征及结局
介绍。由SARS-CoV-2冠状病毒引起的大流行具有显著的发病率和死亡率。肾移植受者由于持续的免疫抑制、高合并症指数和年龄大,感染冠状病毒的风险较高。目的探讨肾移植术后新型冠状病毒感染的临床过程、治疗方法及预后特点。材料和方法。回顾性研究纳入了69名成人肾移植受者,他们在2020年4月至2021年2月期间接受了移植肾脏病学服务的持续随访,并患上了COVID-19。对两组临床表现、实验室及仪器检查结果、治疗特点及转归进行比较研究。临床症状以高热(85.5%,n= 59)、虚弱(65.2%,n=45)、咳嗽(52.2%,n=36)最为常见,其他症状较少见。在89.5%的病例(n=60)中,聚合酶链反应至少检测到一次病毒核糖核酸;10.5%的病例(n=7)聚合酶链反应结果为阴性。CT检查肺组织病变范围为CT1期28例(46.7%),CT2期24例(40%);只有8例(13%)患者的病变被评估为CT3。随后,肺损伤超过50%的患者增加到16例(26.7%),其中1例肺组织损伤严重程度与CT4一致。所有患者的典型特征是不同程度的贫血和淋巴细胞减少,低蛋白血症,实验室检测结果中血清肌酐和尿素、c反应蛋白、铁蛋白、降钙素原和d -二聚体升高。治疗包括抗病毒、抗菌、抗凝治疗、皮质类固醇、生物抗细胞因子药物。在95%的病例(n=66)中,维持性免疫抑制治疗改为完全停用某些成分。移植功能正常的患者生存率为76.8% (n=53), 4.3%的患者(n=3)出现移植物丢失,18.8%的患者(n=13)出现死亡。死亡原因为严重呼吸窘迫综合征合并多脏器功能障碍合并脓毒症和感染性休克8例(61.5%)。有创通气和血液透析与17.2相关(p<0.00001)。免疫抑制调整应个性化考虑感染的严重程度,年龄,合并症,移植后的时间框架和排斥反应的风险。
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