Background
COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. By detecting modifiable and nonmodifiable determinants associated with the severity of COVID-19 infection, the study provides imperative information for the reshaping of renal transplantation in this crucial period.
Methods
Patients who underwent kidney transplantation and follow up in two hospitals in Paris were enrolled. Patients were screened for baseline and transplant characteristics, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19 (Fig 1).
Results
Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05;
P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). Clinical manifestations and outcomes of COVID-19–positive patients are described in Table 1. The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19–positive patients.
Discussion
This study provides an insight into COVID-19 disease in a large population of immunocompromised patients. With a total number of 1216 kidney transplant recipients, we were able to estimate the clinical effect of SARS-CoV-2 over 8 weeks, which corresponded to the ascending and peak phases of the epidemic. Around 5% of patients developed COVID-19 disease, and their mortality was 1%. The study demonstrates the greater role of two nonmodifiable elements in the SARS-CoV-2–related disease in patients with kidney transplants: comorbidities and ethnic groups.
Conclusions
Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.
References
1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395: 497–506, 2020
2. World Health Organization: Coronavirus Disease (COVID-19)—events as they happen, 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. Accessed May 8, 2020
3. Johns Hopkins University of Medicine Coronavirus Resource Center: COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University ( JHU), 2020. Available at: hps://coronavirus.jhu.edu/map.html. Accessed May 8, 2020
4. Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al: Covid-19 and kidney transplantation. N Engl J Med 382: 2475–2477, 2020 pmid:32329975
5. Columbia University Kidney Transplant Program: Early description of coronavirus 2019 disease in kidney transplant recipients in New York. J Am Soc Nephrol 31: 1150–1156, 2020 pmid:32317402
6. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M: COVID-19 infection in kidney transplant recipients. Kidney Int 97: 1076–1082, 2020 pmid:32354637
7. Coates PT, Wong G, Drueke T, Rovin B, Ronco P; Associate Editors, for the Entire Editorial Team: Early experience with COVID-19 in kidney transplantation. Kidney Int 97: 1074–1075, 2020
8. Fernández-Ruiz M, Andrés A, Loinaz C, Delgado JF, López-Medrano F, San Juan R, et al: COVID-19 in solid organ transplant recipients: A single-center case series from Spain. Am J Transplant 20: 1849–1858, 2020 pmid:32301155
9. Pareek M, Bangash MN, Pareek N, Pan D, Sze S, Minhas JS, et al: Ethnicity and COVID-19: An urgent public health research priority. Lancet 395: 1421–1422, 2020
10. Government of France: Carte et donnees covid 19 en France, 2020. Available at: hps://www.gouvernement.fr/info-coronavirus/carte-et-donnees. Accessed June 19, 2020
11. World Health Organization: Coronavirus disease (COVID-19) advice for the public, 2020. Available at: hps://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for public. Accessed May 8, 2020
12. Yancy CW: COVID-19 and African Americans. JAMA 323: 1891–1892, 2020
13. The Francophone Society of Transplantation: COvid-19, 2020. Available at: hps://www.transplantation-francophone.org/covid-19. Accessed June 21, 2020
