Lúcio R Requião-Moura1,2,3, Tainá Veras de Sandes-Freitas4,5,6, Laila Almeida Viana2, Marina Pontello Cristelli2, Luis Gustavo Modelli de Andrade7, Valter Duro Garcia8, Claudia Maria Costa de Oliveira5, Ronaldo de Matos Esmeraldo6, Mario Abbud Filho9, Alvaro Pacheco-Silva3, Katia Cronemberger Sousa10, Alessandra Rosa Vicari11, Kellen Micheline Alves Henrique Costa12, Denise Rodrigues Simão13, Marcos Vinicius de Sousa14, Juliana Bastos Campos15, Ricardo Augusto Monteiro de Barros Almeida7, Luciane Mônica Deboni16, Miguel Moysés Neto17, Juliana Aparecida Zanocco18, Helio Tedesco-Silva1,2, José Medina-Pestana1,2. 1. Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, SP, Brazil. 2. Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil. 3. Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 4. Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil. 5. Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil. 6. Hospital Geral de Fortaleza, Fortaleza, CE, Brazil. 7. Department of Internal Medicine, Universidade Estadual Paulista-UNESP, Botucatu, SP, Brazil. 8. Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil. 9. Hospital de Base, Medical School FAMERP, São José do Rio Preto, SP, Brazil. 10. Federal University of Maranhão, São Luiz, MA, Brazil. 11. Hospital de Clínicas de Porto Alegre, Federal Univertisy of Rio Grande do Sul, Porto Alegre, RS, Brazil. 12. Division of Nephrology and Kidney Transplantation, Onofre Lopes University Hospital, Natal, RN, Brazil. 13. Hospital Santa Isabel, Blumenau, SC, Brazil. 14. Division of Nephrology, Renal Transplant Unit, Renal Transplant Research Laboratory, School of Medical Sciences, University of Campinas-UNICAP, Campinas, SP, Brazil. 15. Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil. 16. Hospital Municipal São José (HMSJ), Joinville, SC, Brazil. 17. Division of Nephrology, School of Medicine of Ribeirão Preto, University of Sao Paulo, Ribeirão Preto, SP, Brazil. 18. Hospital Santa Marcelina, São Paulo, SP, Brazil.
Abstract
BACKGROUND: Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM: To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS: This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS: The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION: The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patients died, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.
BACKGROUND: Kidney transplant (KT) recipients are considered a high-risk group for unfavorable outcomes in the course of coronavirus disease 2019 (COVID-19). AIM: To describe the clinical aspects and outcomes of COVID-19 among KT recipients. METHODS: This multicenter cohort study enrolled 1,680 KT recipients diagnosed with COVID-19 between March and November 2020, from 35 Brazilian centers. The main outcome was the 90-day cumulative incidence of death, for the entire cohort and according to acute kidney injury (AKI) and renal replacement therapy (RRT) requirement. Fatality rates were analyzed according to hospitalization, intensive care unit (ICU) admission, and mechanical ventilation (MV) requirement. Multivariable analysis was performed by logistic regression for the probability of hospitalization and death. RESULTS: The median age of the recipients was 51.3 years, 60.4% were men and 11.4% were Afro-Brazilian. Comorbidities were reported in 1,489 (88.6%), and the interval between transplantation and infection was 5.9 years. The most frequent symptoms were cough (54%), myalgia (40%), dyspnea (37%), and diarrhea (31%), whereas the clinical signs were fever (61%) and hypoxemia (13%). Hospitalization was required in 65.1%, and immunosuppressive drugs adjustments were made in 74.4% of in-hospital patients. ICU admission was required in 34.6% and MV in 24.9%. In the multivariable modeling, the variables related with the probability of hospitalization were age, hypertension, previous cardiovascular disease, recent use of high dose of steroid, and fever, dyspnea, diarrhea, and nausea or vomiting as COVID-19 symptoms. On the other hand, the variables that reduced the probability of hospitalization were time of COVID-19 symptoms, and nasal congestion, headache, arthralgia and anosmia as COVID-19 symptoms. The overall 90-day cumulative incidence of death was 21.0%. The fatality rates were 31.6%, 58.2%, and 75.5% in those who were hospitalized, admitted to the ICU, and required MV, respectively. At the time of infection, 23.2% had AKI and 23.4% required RRT in the follow-up. The cumulative incidence of death was significantly higher among recipients with AKI (36.0% vs. 19.1%, P < 0.0001) and in those who required RRT (70.8% vs. 10.1%, P < 0.0001). The variables related with the probability of death within 90 days after COVID-19 were age, time after transplantation, presence of hypertension, previous cardiovascular disease, use of tacrolimus and mycophenolate, recent use of high dose of steroids, and dyspnea as COVID-19 symptom. On the other hand, the variables that reduced the risk of death were time of symptoms, and headache and anosmia as COVID-19 symptoms. CONCLUSION: The patients diagnosed with COVID-19 were long-term KT recipients and most of them had some comorbidities. One in every five patientsdied, and the rate of death was significantly higher in those with AKI, mainly when RRT was required.
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Authors: Paolo R Salvalaggio; Gustavo F Ferreira; Yasar Caliskan; Luke S Vest; Mark A Schnitzler; Taina V de Sandes-Freitas; Lucio R Moura; Ngan N Lam; Rafael A Maldonado; Alexandre Loupy; David A Axelrod; Krista L Lentine Journal: Transpl Infect Dis Date: 2020-12-19
Authors: Chiara Cantarelli; Andrea Angeletti; Laura Perin; Luis Sanchez Russo; Gianmarco Sabiu; Manuel Alfredo Podestà; Paolo Cravedi Journal: Clin Kidney J Date: 2022-07-27
Authors: Tainá Veras de Sandes-Freitas; Marina Pontello Cristelli; Lucio Roberto Requião-Moura; Luís Gustavo Modelli de Andrade; Laila Almeida Viana; Valter Duro Garcia; Claudia Maria Costa de Oliveira; Ronaldo de Matos Esmeraldo; Paula Roberta de Lima; Ida Maria Maximina Fernandes Charpiot; Teresa Cristina Alves Ferreira; Rodrigo Fontanive Franco; Kellen Micheline Alves Henrique Costa; Denise Rodrigues Simão; Gustavo Fernandes Ferreira; Viviane Brandão Bandeira de Mello Santana; Ricardo Augusto Monteiro de Barros Almeida; Luciane Monica Deboni; Anita Leme da Rocha Saldanha; Irene de Lourdes Noronha; Lívia Cláudio de Oliveira; Deise De Boni Monteiro de Carvalho; Reinaldo Barreto Oriá; Jose Osmar Medina-Pestana; Helio Tedesco-Silva Junior Journal: Transpl Int Date: 2022-02-01 Impact factor: 3.782