Clinical Profile and Outcomes of COVID-19 in Renal Transplant Recipients
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Keywords
acute kidney injury, corona virus disease, intensive care unit, renal transplant recipients, mycophenolate mofetil
Abstract
There is minimal information on coronavirus disease 2019 (COVID-19) in developing countries regarding renal transplant recipients (RTRs). This paper aimed to study the clinical profile, immunosuppressive regimen, treatment, and outcomes in an RTR with COVID-19. This retrospective study was conducted in the nephrology department of Sri Aurobindo Medical College & Postgraduate Institute, Indore (MP), India, from April 1, 2020 to December 15, 2020. We studied 15 patients, of which 13 were treated at our hospital and two were treated in OPD. The median age of transplant recipients was 45 (Interquartile range [IQR]: 26–62) years, the majority being males, and recipients presented at a median of 4 (IQR: 0.3–11) years after transplant. The most common comorbidities included hypertension in 14 (94%) and diabetes 3 (20%) patients. The presenting symptoms at presentation were cough (80%), headache (52%), fever (46%), and breathlessness (26%). Clinical severity as per computerized tomography (CT) severity score ranged from mild (20%), moderate (53%), and severe (27%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (100%). Antiviral therapy (Favipiravir and Remdesivir) was associated with better outcomes and reduced hospital stay. Risk factors for mortality included ABO-incompatibility, severity of disease, high Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) score, allograft dysfunction before COVID-19 infection, acute kidney injury, elevated inflammatory markers, and intensive care unit/ventilator requirement. Overall patient mortality was 13.2%. Risk factor for mortality in COVID-19 positive with RTR appears to be ABO-incompatible transplant, having a previous history of rejection, and patient requiring ventilatory support.
References
2. Kute V, Ramesh V, Shroff S, Guleria S, Prakash J. Deceased-donor organ transplantation in India: Current status, challenges, and solutions. Exp Clin Transplant. 2020 Jul 1;18(Suppl 2):31–42. 10.6002/ect.rlgnsymp2020.L6
3. Ministry of Health and Family Welfare. Available from: https://www.mohfw.gov.in/. Accessed September 13, 2020.
4. Cravedi P, Mothi SS, Azzi Y, Haverly M, Farouk SS, Pérez-Sáez MJ, et al. COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium. Am J Transplant. 2020 Nov;20(11):3140–8. 10.1111/ajt.16185
5. Bossini N, Alberici F, Delbarba E, Valerio F, Manenti C, Possenti S, et al. Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID Task Force experience. Am J Transplant. 2020 Nov;20(11):3019–29. 10.1111/ajt.16176
6. Avery RK. COVID-19 therapeutics for solid organ transplant recipients; 6 months into the pandemic: Where are we now? Transplantation. 2021;105(1):56–60. 10.1097/TP.0000000000003519
7. Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and kidney transplantation. New Eng J Med. 2020 Jun 18;382(25):2475–7. 10.1056/NEJMc2011117
8. Caillard S, Anglicheau D, Matignon M. An initial report from the French SOT COVID Registry suggests high mortality due to Covid-19 in recipients of kidney transplants. Kidney Int. (Published online ahead of print August 24, 2020) 2020 Dec 98(6):1549–58. 10.1016/j.kint.2020.08.005
9. Stephanie GY, Rogers AW, Saharia A, Aoun M, Faour R, Abdelrahim M, et al. Early experience with COVID-19 and solid organ transplantation at a US high-volume transplant center. Transplantation. 2020 Nov;104(11):2208. 10.1097/TP.0000000000003339
10. Hilbrands LB, Duivenvoorden R, Vart P, Franssen CF, Hemmelder MH, Jager KJ, et al. COVID-19-related mortality in kidney transplant and dialysis patients: Results of the ERACODA collaboration. Neph Dialysis Transplant. 2020 Nov;35(11):1973–83.
11. Shingare A, Bahadur MM, Raina S. COVID-19 in recent kidney transplant recipients. Am J Transplant. 2020 Nov;20(11):3206–9. 10.1111/ajt.16120
12. Kates OS, Fisher CE, Stankiewicz-Karita HC, Shepherd AK, Church EC, Kapnadak SG, et al. Earliest cases of coronavirus disease 2019 (COVID-19) identified in solid organ transplant recipients in the United States. Am J Transplant. 2020 Jul;20(7):1885–90. 10.1111/ajt.15944
13. National Clinical Management Protocol COVID-19. Clinical management protocol: COVID-19 [Internet]. Available from: https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19.pdf. Accessed 15 December, 2020.
14. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: Correlation with disease severity and short-term prognosis. Eur Radiol. 2020 Dec;30(12):6808–17. 10.1007/s00330-020-07033-y
15. Revised discharge policy for Covid-19 [Internet]. Available from: https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf. Accessed December 15, 2020.
16. Uematsu J, Sakai-Sugino K, Kihira-Nakanishi S, Yamamoto H, Hirai K, Kawano M, et al. Inhibitions of human parainfluenza virus type 2 replication by ribavirin and mycophenolate mofetil are restored by guanosine and S-(4-nitrobenzyl)-6-thioinosine. Drug Discov Therap. 2019 Dec 31;13(6):314–21. 10.5582/ddt.2019.01084
17. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. Management of patients on dialysis and with kidney transplant during COVID-19 coronavirus infection. Kidneys. 2020;9(2):117–20. 10.22141/2307-1257.9.2.2020.203411
18. Devaux CA, Rolain JM, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: What to expect for COVID-19? Int J Antimicrob Agents. 2020 May 1;55(5):105938. 10.1016/j.ijantimicag.2020.105938
19. Patel A, Shah K, Dharsandiya M, Patel K, Patel T, Patel M, et al. Safety and efficacy of tocilizumab in the treatment of severe acute respiratory syndrome Coronavirus-2 pneumonia: A retrospective cohort study. Indian J Med Microbiol. 2020 Jul 1;38(1):116–22. 10.4103/ijmm.IJMM_20_298
20. Tatapudi RR, Kopparti VR, Poosapati A, Metta S, Gongada AR, Vedulla B. SARS-CoV-2 Infection in kidney transplant recipients: A single-centre study of 20 cases from India. Int J Nephrol. 2021 Nov 5;2021: Article ID 2243095. 10.1155/2021/2243095
21. Ali T, Al-Ali A, Fajji L, Hammad E, Nazmi A, Alahmadi I, et al. Coronavirus disease-19: Disease severity and outcomes of solid organ transplant recipients: Different spectrums of disease in different populations. Transplantation. 2021 Jan 1;105(1):121–7. 10.1097/TP.0000000000003433
22. Husain SA, Dube G, Morris H, Fernandez H, Chang JH, Paget K, et al. Early outcomes of outpatient management of kidney transplant recipients with coronavirus disease 2019. Clin J Am Soc Nephrol. 2020 Aug 7;15(8):1174–8. 10.2215/CJN.05170420
23. Felldin M, Søfteland JM, Magnusson J, Ekberg J, Karason K, Schult A, et al. Initial report from a Swedish high-volume transplant center after the first wave of the COVID-19 pandemic. Transplantation. 2021 Jan 1;105(1):108–14. 10.1097/TP.0000000000003436
24. Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, et al. Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res. 2020 Jan 1;152(1):61. 10.4103/ijmr.IJMR_1788_20
25. Chatterjee P. Is India missing COVID-19 deaths? Lancet. 2020 Sep 5;396(10252):657. 10.1016/S0140-6736(20)31857-2
26. Jha PK, Yadav DK, Siddini V, Bansal SB, Sharma R, Anandh U, et al. A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic. Clin Transplant. 2021 Jul;35:e14423. 10.1111/ctr.14423
27. Jasuja S, Sagar G, Bahl A, Verma S. COVID-19 infection clinical profile, management, outcome, and antibody response in kidney transplant recipients: A single centre experience. Int J Nephrol. 2021 Oct 3;2021: Article ID 3129411, 10 pages. 10.1155/2021/3129411
28. Mishra V, Burma AD, Das SK, Parivallal MB, Amudhan S, Rao GN. COVID-19-hospitalized patients in Karnataka: Survival and stay characteristics. Indian J Public Health. 2020 Jun 1;64(6):221. 10.4103/ijph.IJPH_486_20
29. Deshpande R, Dash S, Bahadur MM, Thamba A, Pathan AK, Dave K, et al. Study of COVID-19 pandemic in representative dialysis population across Mumbai, India: An observational multicentric analysis. J Ass Physicians India. 2020 Oct 1;68(10):13–7.
30. Trivedi M, Shingada A, Shah M, Khanna U, Karnik ND, Ramachandran R. Impact of COVID-19 on maintenance haemodialysis patients: The Indian scenario. Nephrology. 2020 Dec;25(12):929–32. 10.1111/nep.13760
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