Department of Cardiology, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Transpl Immunol. 2023 Feb;76:101772. doi: 10.1016/j.trim.2022.101772. Epub 2022 Dec 8.
The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality since late 2019. Patients undergoing kidney transplantation (KT) are prone to COVID-19 due to immunosuppressive drug use and various comorbidities such as hypertension and diabetes.
One hundred thirty-three KT recipients with COVID-19 were included in this retrospective cohort study. Hospital mortality was considered a primary outcome, while acute kidney injury (AKI) was considered a secondary outcome. Demographic information, maintenance immunosuppression, medical history, laboratory information, and echocardiographic and electrocardiography results of patients were recorded. Patients were also followed for 2 months post-discharge for post-COVID-19 symptoms, readmission, and transplant function.
Regarding the primary outcome of the 133 patients, 13 died and 120 survived. The deceased patients were significantly older (median age, 64 vs. 50.5 years; p = 0.04) and had a significantly higher median serum creatinine level (p = 0.002) and lower median glomerular filtration rate (p = 0.010) than patients who survived. The incidence of AKI was 47.3%, more common in deceased patients (p = 0.038) than in patients who survived. Troponin levels were significantly higher in deceased patients and those with AKI (p = 0.0004 and p = 0.039, respectively) than in patients who survived and those without AKI. A multivariable Cox regression analysis revealed that older age (adjusted hazard ratio, 1.13; 95% confidence interval, 1.01-1.27) and AKI (adjusted hazard ratio, 3.43; 95% confidence interval, 1.34-8.79) were associated with in-hospital mortality.
In conclusion, kidney recipients with COVID-19 had a higher mortality rate than the general population, with a higher prevalence in older individuals and those who experienced AKI during hospitalization than in patients who survived and those without AKI.
自 2019 年底以来，新型冠状病毒病（COVID-19）大流行导致了大量死亡。由于使用免疫抑制剂药物以及高血压和糖尿病等各种合并症，接受肾移植（KT）的患者容易感染 COVID-19。
本回顾性队列研究纳入了 133 例 COVID-19 肾移植受者。住院死亡率被视为主要结局，急性肾损伤（AKI）被视为次要结局。记录患者的人口统计学信息、维持性免疫抑制、病史、实验室信息以及超声心动图和心电图结果。还对患者进行了 2 个月的随访，以了解 COVID-19 后症状、再次入院和移植功能情况。
关于 133 例患者的主要结局，有 13 例死亡，120 例存活。死亡患者的年龄明显较大（中位数年龄，64 岁比 50.5 岁；p=0.04），血清肌酐水平中位数明显较高（p=0.002），肾小球滤过率中位数明显较低（p=0.010）。AKI 的发生率为 47.3%，在死亡患者中更常见（p=0.038），而在存活患者中则不然。死亡患者和发生 AKI 的患者的肌钙蛋白水平明显较高（p=0.0004 和 p=0.039），而存活患者和未发生 AKI 的患者则不然。多变量 Cox 回归分析显示，年龄较大（调整后的危险比，1.13；95%置信区间，1.01-1.27）和 AKI（调整后的危险比，3.43；95%置信区间，1.34-8.79）与住院死亡率相关。
总之，COVID-19 肾移植受者的死亡率高于一般人群，在年龄较大的个体以及住院期间发生 AKI 的患者中更为常见，而在存活患者和未发生 AKI 的患者中则不然。
