Frontiers in Medicine (Apr 2024)

Clinical characteristics and outcomes in COVID-19 in kidney transplant recipients: a propensity score matched cohort study

  • Polianna Delfino-Pereira,
  • Polianna Delfino-Pereira,
  • Vanessa das Graças José Ventura,
  • Magda Carvalho Pires,
  • Daniela Ponce,
  • Gabriel Assis Lopes do Carmo,
  • Gabriel Assis Lopes do Carmo,
  • Lilian Pires de Freitas do Carmo,
  • Lilian Pires de Freitas do Carmo,
  • Bruno Barbosa Miranda de Paiva,
  • Alexandre Vargas Schwarzbold,
  • Angélica Gomides dos Reis Gomes,
  • Bruno Mateus de Castro,
  • Carísi Anne Polanczyk,
  • Carísi Anne Polanczyk,
  • Christiane Corrêa Rodrigues Cimini,
  • Christiane Corrêa Rodrigues Cimini,
  • Daniela Antunes de Lima,
  • Fabiano Carvalho de Sousa,
  • Frederico Bartolazzi,
  • Giovanna Grunewald Vietta,
  • Heloisa Reniers Vianna,
  • José Miguel Chatkin,
  • Karen Brasil Ruschel,
  • Karen Brasil Ruschel,
  • Karen Brasil Ruschel,
  • Luciane Kopittke,
  • Luís César de Castro,
  • Marcelo Carneiro,
  • Priscilla Pereira dos Reis,
  • Milena Soriano Marcolino,
  • Milena Soriano Marcolino,
  • Milena Soriano Marcolino

DOI
https://doi.org/10.3389/fmed.2024.1350657
Journal volume & issue
Vol. 11

Abstract

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Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.

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