Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India
Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India
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DOI：
10.1097/tp.0000000000003593
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发表时间：
2021-04-01
期刊：
影响因子：
6.2
通讯作者：
Mishra, Vineet V.
中科院分区：
文献类型：
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作者：
Kute, Vivek B.;Bhalla, Anil K.;Mishra, Vineet V.
背景：关于冠状病毒疾病后果的数据稀缺-19方法：在这里，我们对印度的13个移植中心进行了一项队列研究，包括250个KTR，（226名在世和24名已故献血者），从2020年3月23日至2020年9月15日，经聚合酶链反应确认为COVID-19阳性。我们详细的人口统计学，免疫抑制方案，临床资料，治疗，和outcomes.Results.Median年龄的移植受者为43岁，和收件人在移植后的中位数为3.5年。最常见的合并症（94%）包括动脉高血压（84%）和糖尿病（32%）; COVID-19出现时的症状包括发热（88%）、咳嗽（72%）和咳痰（52%）。临床严重程度范围为无症状（6%）、轻度（60%）和中度（20%）至重度（14%）。调整免疫抑制剂的策略包括停用抗代谢药，而不改变钙调磷酸酶抑制剂和类固醇（60%）。死亡的风险因素包括年龄较大;呼吸困难;严重疾病;肥胖; COVID-19感染前的同种异体移植物功能障碍;急性肾损伤;炎症标志物水平较高，包括C反应蛋白、白细胞介素-6水平和降钙素原;胸部X线异常和重症监护室/呼吸机需求。总体患者死亡率为11.6%（29/250），住院患者为14.5%（29/200），重症监护室患者为47%（25/53），需要通气的患者为96.7%（29/30）。在COVID-19大流行期间，有轻度COVID-19症状的KTR（n = 50）作为门诊患者进行管理，以优化稀缺资源的利用。结论：COVID-19阳性KTR的死亡率似乎高于非免疫抑制患者，需要重症监护和使用呼吸机的患者死亡率较高。
Background.There is a scarcity of data on the consequences of coronavirus disease-19 (COVID-19) infections in kidney transplant recipients (KTRs) from emerging countries.Methods.Here, we present a cohort study of 13 transplant centers in India including 250 KTR (226 living and 24 deceased donors) with polymerase chain reaction-confirmed COVID-19 positivity from March 23, 2020, until September 15, 2020. We detailed demographics, immunosuppression regimen, clinical profile, treatment, and outcomes.Results.Median age of transplant recipients was 43 years, and recipients presented at a median of 3.5 years after transplant. Most common comorbidities (94%) included arterial hypertension (84%) and diabetes (32%); presenting symptoms at the time of COVID-19 included fever (88%), cough (72%), and sputum production (52%). Clinical severity ranged from asymptomatic (6%), mild (60%), and moderate (20%) to severe (14%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (60%). Risk factors for mortality included older age; dyspnea; severe disease; obesity; allograft dysfunction before COVID-19 infection; acute kidney injury; higher levels of inflammatory markers including C-reactive protein, interleukin-6 level, and procalcitonin; chest X-ray abnormality, and intensive care unit/ventilator requirements. Overall patient mortality was 11.6% (29 of 250), 14.5% (29 of 200) in hospitalized patients, 47% (25 of 53) in intensive care unit patients, and 96.7% (29 of 30) in patients requiring ventilation. KTRs with mild COVID-19 symptoms (n = 50) were managed as outpatients to optimize the utilization of scarce resources during the COVID-19 pandemic.Conclusions.Mortality rates in COVID-19-positive KTR appear to be higher than those in nonimmunosuppressed patients, and high mortality was noted among those requiring intensive care and those on ventilator.