Article Figures & Data
Figures
- Figure 1.
The figure illustates the design of this observational prospective cohort study performed in 1216 kidney transplant recipients with active follow-up in two referral transplant centers. COVIDOM, commercial name of patients' application; ORBIS, commercial name of medical software; PMC, medical hotline platform; pts, patients.
Tables
- Table 1.
Baseline characteristics of the study population according to the presence of COVID-19 disease after kidney transplantation
Demographic Characteristics All Patients, n=1216 COVID-19–Positive Patients, n=66 COVID-19–Negative Patients, n=1150 P Valuea Age, yr 54.1±13.4 56.4±12.5 54.0±13.4 0.14 Men, no. (%) 777 (64) 37 (56) 740 (64) 0.17 Non-White, no. (%) 222 (24) 24 (36) 198 (17) <0.001 Blood group, no. (%) 0.90 A 463 (38) 23 (35) 440 (38) B 194 (16) 12 (18) 182 (16) O 489 (40) 28 (42) 461 (40) AB 70 (6) 3 (5) 67 (6) Cause of ESKD, no. (%) 0.13 Glomerulopathies 254/1206 (21) 7/66 (11) 247/1140 (22) Diabetes 195/1206 (16) 12/66 (18) 183/1140 (16) Vascular 209/1206 (17) 16/66 (24) 196/1140 (17) Other 548/1206 (46) 31/66 (47) 514/1140 (45) Deceased donor, no. (%) 1053 (87) 64 (97) 989 (86) <0.001 Prior kidney transplant, no. (%) 132 (11) 8 (12) 124 (11) 0.69 Time on dialysis prior to transplantation, mob 49.4±42 57.8±46.2 48.8±41.8 0.09 Multiorgan recipients, no. (%) 96 (8) 4 (6) 92 (8) 0.57 Clinical Features and Outcomes All Patients, n=66 Invasive Mechanical Ventilation, n=15 No Invasive Mechanical Ventilation, n=51 Features at diagnosis Clinical presentation, no. (%) Fever 51 (77) 12 (80) 39 (76) Cough 38 (58) 11 (73) 27 (53) Dyspnea (exertional or rest) 26 (39) 12 (80) 14 (27) Diarrhea 17 (26) 2 (13) 15 (29) Anosmia/ageusia 7 (11) 0 (0) 7 (14) Laboratory testsa White blood cell count, 1000/µl, median (range)a 5.9 (1.6–14.2) 7.4 (2.6–14.2) 5.3 (1.6–13.2) Absolute lymphocyte count, /µl 528 (80–1300) 473 (80–1180) 548 (169–1300) C-reactive protein, mg/L 115 (0–335) 159 (18–316) 96 (0–335) Chest x-ray/pulmonary CT scan,a no. (%) Multifocal/bilateral patchy opacities 38/56 (68) 12/13 (92) 26/43 (60) Lobar opacities 3/56 (5) 1/13 (8) 2/43 (5) No acute findings 15/56 (27) 0/13 (0) 15/43 (35) Immunosuppressive treatment, no. (%) MMF/MPA/AZA 61 (92) 13 (87) 48 (94) CNI 57 (86) 14 (93) 43 (84) Belatacept 6 (9) 1 (7) 5 (10) Steroids 55 (83) 13 (87) 42 (82) Treatment and outcome Change in immunosuppression, no. (%) Discontinued only MMF/MPA/AZA 38/61 (62) 13 (100) 25/48 (52) Discontinued only CNI 2/57 (4) 2/14 (14) 0 Belatacept infusion postpone 1/6 (17) 0 1/5 (20) No change 24 (36) 2 (13) 22 (43) Discontinued all immunosuppression 1 (2) 1 (7) 0 Anti–COVID-19 therapies, no. (%) Hydroxychloroquine 7 (11) 4 (27) 3 (6) Tocilizumab 1 (2) 0 (l0) 1 (2) Eculizumab 2 (3) 0 (0) 2 (4) Outcomes, no. (%) AKI 28 (42) 13 (87) 15 (29) RRT required 7 (11) 7 (47) 0 (0) Died 16 (24) 11 (73) 5 (10) Recovery 50 (76) 4 (27) 46 (90) Data are displayed as n (%) or median (range). CT, computed tomography; MMF, mycophenolate mofetil; MPA, mycophenolic acid; AZA, azathioprine; CNI, calcineurin inhibitor.
↵a Data recorded in the 60 hospitalized patients, with missing data for two patients in the invasive mechanical ventilation group and two patients in the noninvasive mechanical ventilation group, for patients admitted to other hospitals.
- Table 3.
Factors assessed at time of post-transplant risk evaluation associated with COVID-19 disease in patients with kidney transplants: univariate and multivariate analysis
Factors Associated with COVID-19 Disease in Kidney Transplant Patients No. of Patients No. of COVID-19–Positive Patients Odds Ratio (95% CI) P Value Factors associated with COVID-19 disease: univariate analysis Recipient characteristics Age, per 1-yr increment 1216 66 1.01 (1.00 to 1.04) 0.15 Sex Women 439 29 1 Men 777 37 0.71 (0.43 to 1.17) 0.17 Ethnicity White 994 42 1 Non-White 222 24 2.75 (1.63 to 4.64) <0.001 Transplant characteristics Donor type Deceased donor 1053 64 1 Living donor 163 2 0.19 (0.05 to 0.79) <0.001 Prior kidney transplant No 1084 58 1 Yes 132 8 0.88 (0.41 to 1.88) 0.69 Time on dialysis before graft per 1-mo increment 1078 66 1.00 (1.00 to 1.01) 0.09 Multiorgan recipient No 1120 62 1 Yes 96 4 1.35 (0.48 to 3.79) 0.57 Time of risk evaluation Time from transplant to evaluation per 1-mo increment 1216 66 0.99 (0.99 to 1.00) 0.02 Functional allograft parameters Recent episode of rejection No 971 54 1 Yes 245 12 0.87 (0.46 to 1.66) 0.68 Serum creatinine per μmol/L increment 1185 66 1.00 (1.00 to 1.01) 0.11 Comorbidities Smoker No 1060 60 1 Yes 156 6 0.67 (0.28 to 1.57) 0.35 Obesity (BMI≥30) No 1043 46 1 Yes 151 20 3.31 (1.90 to 5.77) <0.001 Diabetes No 926 35 1 Yes 290 31 3.05 (1.84 to 5.04) <0.001 Hypertension No 287 8 1 Yes 929 58 2.32 (1.10 to 4.92) 0.02 Asthma and chronic pulmonary disease No 1138 53 1 Yes 78 13 4.09 (2.12 to 7.89) <0.001 Cardiovascular disease No 1146 65 1 Yes 70 1 0.24 (0.03 to 1.76) 0.17 Maintenance immunosuppressive therapies Prednisone No 368 11 1 Yes 829 55 2.31 (1.19 to 4.46) 0.01 Tacrolimus No 510 29 1 Yes 691 37 0.94 (0.57 to 1.55) 0.80 Cyclosporin No 841 46 1 Yes 360 20 1.02 (0.59 to 1.74) 0.95 Mycophenolate mofetil or mycophenolic acid No 201 13 1 Yes 996 53 0.81 (0.43 to 1.52) 0.51 Belatacept No (CNI regimen)a 1051 57 0.61 (0.25 to 1.47) 0.28 Yes 70 6 1 Azathioprine No 1047 58 1 Yes 150 8 0.96 (0.45 to 2.05) 0.92 Factors associated with COVID-19 disease: multivariate model Prednisoneb No 293 11 1 Yes 741 55 1.67 (0.87 to 3.47) 0.15 Ethnicity White 829 42 1 Non-White 205 24 2.17 (1.23 to 3.78) 0.007 Cardiovascular disease No 970 65 1 Yes 64 1 0.20 (0.03 to 1.50) 0.12 Obesity (BMI≥30) No 900 46 1 Yes 134 20 2.19 (1.19 to 4.05) 0.01 Asthma and chronic pulmonary disease No 964 53 1 Yes 70 13 3.09 (1.49 to 6.41) 0.002 Diabetes No 785 35 1 Yes 249 31 3.33 (1.92 to 5.77) <0.001 Time on dialysis before graft per 1-mo increment 1034 66 1.01 (0.99 to 1.01) 0.07 OR, odds ratio; BMI, body mass index; CNI, calcineurin inhibitor (cyclosporin or tacrolimus).
↵a Three patients did not take either CNI or belatacept.
↵b The multivariable analysis was restricted to 1034 patients without any missing data for each of the variables included in the final model by the stepwise backward elimination.
Supplemental Data
In this issue
