Giusti Sixto, Chazin Shai, Vaitla Pradeep, Atiemo Kofi, Atari Mohammad, Paramesh Anil, Jeon Hoonbae, Torres-Ortiz Aldo, Thimmisetty Ravi, Garces Jorge
Department of Medicine, Section of Nephrology and Hypertension, Tulane University School of Medicine, New Orleans, LA.
Department of Surgery, Kidney and Pancreas Transplant Program, Tulane University School of Medicine, New Orleans, LA.
Ochsner J. 2021 Winter;21(4):329-334. doi: 10.31486/toj.21.0008.
Kidney transplant recipients are at increased risk of severe disease and death caused by coronavirus disease 2019 (COVID-19) infection. The role of immunosuppressive medications in the clinical presentation, disease course, and outcomes is not well understood. We analyzed kidney transplant recipients diagnosed with COVID-19 and requiring hospitalization during the initial infection surge at 2 large transplant centers in New Orleans, Louisiana, between February 1, 2020 and April 30, 2020. Patient presentation, clinical course, kidney transplant function, and postdischarge details are included in this analysis. Twenty-three kidney transplant recipients hospitalized with COVID-19 were included in the study. The majority of patients were Black (95.7%). Diabetes, hypertension, and obesity were present in more than 50% of the patients. The most common presenting symptom was fever, present in 52.2% of patients. All patients were managed with reduction in immunosuppression. Patients received azithromycin (60.9%), hydroxychloroquine (47.8%), remdesivir (8.7%), and intravenous methylprednisolone pulse (8.7%). The average length of stay was 4.5 days (range, 2-18 days). In this study population, 73.9% of the patients sustained acute kidney injury, with an average peak serum creatinine of 3.81 mg/dL. Twenty-six percent of the patients required renal replacement therapy. Seventy-seven percent of patients developed proteinuria (at least 1+ proteinuria on urinalysis). Of the patients in this population who required mechanical ventilation (39.1%), 77.8% died. Overall, 30.4% of patients died of COVID-19-related complications during admission. Of the 16 patients discharged, the average serum creatinine at discharge was 2.09 mg/dL compared with an average preadmission serum creatinine of 1.8 mg/dL. During the initial COVID-19 infection surge in New Orleans, we noted that kidney transplant recipients had initial symptoms similar to the general population. However, we recorded a higher incidence of acute kidney injury and death compared to nontransplant patients. Patients who required mechanical ventilation had a high mortality rate. Black patients are overrepresented in our study.
肾移植受者感染2019冠状病毒病（COVID-19）后发生重症和死亡的风险增加。免疫抑制药物在临床表现、病程和结局中的作用尚不完全清楚。我们分析了2020年2月1日至2020年4月30日期间在路易斯安那州新奥尔良市的2家大型移植中心初次感染高峰时被诊断为COVID-19并需要住院治疗的肾移植受者。该分析包括患者的临床表现、临床病程、肾移植功能及出院后详情。23例因COVID-19住院的肾移植受者被纳入研究。大多数患者为黑人（95.7%）。超过50%的患者患有糖尿病、高血压和肥胖症。最常见的首发症状是发热，52.2%的患者出现该症状。所有患者均通过减少免疫抑制进行治疗。患者接受了阿奇霉素（60.9%）、羟氯喹（47.8%）、瑞德西韦（8.7%）和静脉注射甲泼尼龙冲击治疗（8.7%）。平均住院时间为4.5天（范围2 - 18天）。在该研究人群中，73.9%的患者发生急性肾损伤，血清肌酐平均峰值为3.81mg/dL。26%的患者需要肾脏替代治疗。77%的患者出现蛋白尿（尿分析至少为1+蛋白尿）。在该人群中需要机械通气的患者（39.1%），77.8%死亡。总体而言，30.4%的患者在住院期间死于COVID-19相关并发症。在16例出院患者中，出院时血清肌酐平均为2.09mg/dL，而入院前血清肌酐平均为1.8mg/dL。在新奥尔良市初次COVID-19感染高峰期间，我们注意到肾移植受者的初始症状与普通人群相似。然而，与非移植患者相比，我们记录到急性肾损伤和死亡的发生率更高。需要机械通气的患者死亡率很高。黑人患者在我们的研究中占比过高。
