Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry |
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Authors: | Florentino Villanego Auxiliadora Mazuecos Isabel M Pérez-Flores Francesc Moreso Amado Andrés Carlos Jiménez-Martín María Molina Cristina Canal Luis A Sánchez-Cámara Sofía Zárraga María del Carmen Ruiz-Fuentes María José Aladrén Edoardo Melilli Verónica López Emilio Sánchez-Álvarez Marta Crespo Julio Pascual for the Spanish Society of Nephrology COVID- Group |
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Institution: | 1. Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain;2. Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain;3. Department of Nephrology, Hospital Vall d´Hebron, Barcelona, Spain;4. Department of Nephrology, Hospital Universitario Doce de Octubre, Madrid, Spain;5. Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain;6. Department of Nephrology, Hospital Germans Trias i Pujol, Barcelona, Spain;7. Department of Nephrology, Fundació Puigvert, Barcelona, Spain;8. Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain;9. Department of Nephrology, Hospital Universitario de Cruces, Bilbao, Spain;10. Department of Nephrology, Hospital Virgen de las Nieves, Granada, Spain;11. Department of Nephrology, Hospital Universitario Miguel Servet, Zaragoza, Spain;12. Department of Nephrology, Hospital Universitario Bellvitge, Barcelona, Spain;13. Department of Nephrology, Hospital Regional Universitario de Málaga, University of Málaga, IBIMA, REDinREN, Málaga, Spain;14. Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain;15. Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN, Barcelona, Spain |
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Abstract: | SARS-CoV-2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID-19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID-19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti-COVID-19 treatment in the second wave (July–December) than in the first one (March–June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post-KT should be considered when selecting recipients for transplantation in the COVID-19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination. |
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Keywords: | clinical research/practice infection and infectious agents – viral kidney transplantation/nephrology patient survival |
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