Bajpai Divya, Deb Satarupa, Bose Sreyashi, Gandhi Chintan, Modi Tulsi, Katyal Abhinav, Saxena Nikhil, Patil Ankita, Thakare Sayali, Pajai Atim E, Haridas Ashwathy, Keskar Vaibhav S, Jawale Sunil Y, Sultan Amar G, Jamale Tukaram E
Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India.
Department of Nephrology, Apollo Hospital, Navi Mumbai, India.
Transpl Int. 2021 Jun;34(6):1074-1082. doi: 10.1111/tri.13886.
Evidence on the evolution of graft function in kidney transplant recipients recovering from coronavirus disease-2019 (COVID-19) is lacking. This multicenter observational study evaluated the short-term clinical outcomes in recipients with acute kidney injury (AKI) secondary to COVID-19. Out of 452 recipients following up at five centers, 50 had AKI secondary to COVID-19. 42 recipients with at least 3-month follow-up were included. Median follow-up was 5.23 months [IQR 4.09-6.99]. Severe COVID-19 was seen in 21 (50%), and 12 (28.6%) had KDIGO stage 3 AKI. Complete recovery of graft function at 3 months was seen in 17 (40.5%) patients. Worsening of proteinuria was seen in 15 (37.5%) patients, and 4 (9.5%) patients had new onset proteinuria. Graft failure was seen in 6 (14.3%) patients. Kidney biopsy revealed acute tubular injury (9/11 patients), thrombotic microangiopathy (2/11), acute cellular rejection (2/11), and chronic active antibody-mediated rejection (3/11). Patients with incomplete recovery were likely to have lower eGFR and proteinuria at baseline, historical allograft rejection, higher admission SOFA score, orthostatic hypotension, and KDIGO stage 3 AKI. Baseline proteinuria and the presence of orthostatic hypotension independently predicted incomplete graft recovery. This shows that graft recovery may remain incomplete after AKI secondary to COVID-19.
关于2019冠状病毒病（COVID-19）康复期肾移植受者移植肾功能演变的证据尚缺。这项多中心观察性研究评估了继发于COVID-19的急性肾损伤（AKI）受者的短期临床结局。在五个中心随访的452名受者中，50名继发于COVID-19的AKI。纳入了42名至少随访3个月的受者。中位随访时间为5.23个月[四分位间距4.09 - 6.99]。21名（50%）出现重症COVID-19，12名（28.6%）有KDIGO 3期AKI。17名（40.5%）患者在3个月时移植肾功能完全恢复。15名（37.5%）患者蛋白尿加重，4名（9.5%）患者出现新发蛋白尿。6名（14.3%）患者移植失败。肾活检显示急性肾小管损伤（9/11例患者）、血栓性微血管病（2/11）、急性细胞性排斥反应（2/11）和慢性活动性抗体介导的排斥反应（3/11）。恢复不完全的患者在基线时可能有较低的估算肾小球滤过率（eGFR）和蛋白尿、既往移植排斥反应、较高的入院序贯器官衰竭评估（SOFA）评分、体位性低血压和KDIGO 3期AKI。基线蛋白尿和体位性低血压的存在独立预测移植恢复不完全。这表明继发于COVID-19的AKI后移植恢复可能仍不完全。
