Division of Nephrology, Montefiore Medical Center Transplant Center, Albert Einstein College of Medicine, Bronx, New York, USA; Einstein-Montefiore Abdominal Transplant Center, Bronx, New York, USA.
Department of Surgery, Montefiore Medical Center Transplant Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Kidney Int. 2020 Dec;98(6):1559-1567. doi: 10.1016/j.kint.2020.10.004. Epub 2020 Oct 16.
We investigated the prevalence and clinical outcomes of COVID-19 in recipients of kidney transplants in the Bronx, New York, one of the epicenters of the pandemic. Between March 16 and June 2, 2020, 132 kidney transplant recipients tested positive by SARS-CoV-2 RT-PCR. From May 3 to July 29, 2020, 912 kidney transplant recipients were screened for SARS-CoV-2 IgG antibodies during routine clinic visits, of which 16.6% tested positive. Fifty-five of the 152 patients had previously tested positive by RT-PCR, while the remaining 97 did not have significant symptoms and had not been previously tested by RT-PCR. The prevalence of SARS-CoV-2 infection was 23.4% in the 975 patients tested by either RT-PCR or SARS-CoV-2 IgG. Older patients and patients with higher serum creatinine levels were more likely diagnosed by RT-PCR compared to SARS-CoV-2 IgG. Sixty-nine RT-PCR positive patients were screened for SARS-CoV-2 IgG antibodies at a median of 44 days post-diagnosis (Inter Quartile Range 31-58) and 80% were positive. Overall mortality was 20.5% but significantly higher (37.8%) in the patients who required hospitalization. Twenty-three percent of the hospitalized patients required kidney replacement therapy and 6.3% lost their allografts. In multivariable analysis, older age, receipt of deceased-donor transplantation, lack of influenza vaccination in the previous year and higher serum interleukine-6 levels were associated with mortality. Thus, 42% of patients with a kidney transplant and with COVID-19 were diagnosed on antibody testing without significant clinical symptoms; 80% of patients with positive RT-PCR developed SARS-CoV-2 IgG and mortality was high among patients requiring hospitalization.
我们调查了纽约布朗克斯区肾移植受者中 COVID-19 的流行情况和临床结果，该地区是大流行的中心之一。2020 年 3 月 16 日至 6 月 2 日期间，132 例肾移植受者的 SARS-CoV-2 RT-PCR 检测呈阳性。2020 年 5 月 3 日至 7 月 29 日，在常规门诊就诊期间，对 912 例肾移植受者进行了 SARS-CoV-2 IgG 抗体筛查，其中 16.6%呈阳性。在 152 名患者中，有 55 名先前通过 RT-PCR 检测呈阳性，而其余 97 名患者没有明显症状，且未通过 RT-PCR 检测。通过 RT-PCR 或 SARS-CoV-2 IgG 检测的 975 例患者中，SARS-CoV-2 感染的患病率为 23.4%。与 SARS-CoV-2 IgG 相比，年龄较大的患者和血清肌酐水平较高的患者更有可能通过 RT-PCR 诊断。69 名 RT-PCR 阳性患者在诊断后中位数为 44 天（31-58 的四分位间距）时接受了 SARS-CoV-2 IgG 抗体筛查，其中 80%呈阳性。总体死亡率为 20.5%，但住院患者的死亡率明显更高（37.8%）。23%的住院患者需要肾脏替代治疗，6.3%的患者失去了移植肾。多变量分析显示，年龄较大、接受已故供体移植、上一年未接种流感疫苗以及血清白细胞介素-6 水平较高与死亡率相关。因此，42%的肾移植受者在没有明显临床症状的情况下通过抗体检测诊断为 COVID-19；80%的 RT-PCR 阳性患者产生了 SARS-CoV-2 IgG，需要住院治疗的患者死亡率较高。
