Villanego Florentino, Mazuecos Auxiliadora, Pérez-Flores Isabel M, Moreso Francesc, Andrés Amado, Jiménez-Martín Carlos, Molina María, Canal Cristina, Sánchez-Cámara Luis A, Zárraga Sofía, Ruiz-Fuentes María Del Carmen, Aladrén María José, Melilli Edoardo, López Verónica, Sánchez-Álvarez Emilio, Crespo Marta, Pascual Julio
Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain.
Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
Am J Transplant. 2021 Jul;21(7):2573-2582. doi: 10.1111/ajt.16579. Epub 2021 Apr 12.
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.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染在肾移植（KT）受者中导致了高死亡率，尤其是在老年受者中。截至2020年12月，西班牙登记处已前瞻性纳入1011例感染新型冠状病毒肺炎（COVID-19）的KT受者，并随访至康复或死亡。在多变量分析中，年龄、肺炎以及在COVID-19感染前≤6个月进行的KT是死亡的预测因素，而胃肠道症状具有保护作用。生存分析显示，根据受者年龄和KT后的时间，四个亚组的死亡风险显著增加（年龄<65岁且移植后时间>6个月、年龄<65岁且时间≤6个月、年龄≥65岁且时间>6个月以及年龄≥65岁且时间≤6个月）：死亡率分别为11.3%、24.5%、35.4%和54.5%（p<0.001）。与第一波（3月至6月）相比，第二波（7月至12月）的患者明显更年轻，肺炎发病率更低，接受特异性抗COVID-19治疗的频率也更低。第二波的总体死亡率较低（15.1%对27.4%，p<0.001），但危重症患者的死亡率相似（66.7%对58.1%，p=0.29）。在COVID-19大流行期间选择移植受者时，应考虑年龄与KT后时间之间的相互作用。高龄和近期进行KT手术应促使采取严格的保护措施，包括接种疫苗。
