Mikhailov Michael, Budde Klemens, Halleck Fabian, Eleftheriadis Georgios, Naik Marcel G, Schrezenmeier Eva, Bachmann Friederike, Choi Mira, Duettmann Wiebke, von Hoerschelmann Ellen, Koch Nadine, Liefeldt Lutz, Lücht Christian, Straub-Hohenbleicher Henriette, Waiser Johannes, Weber Ulrike, Zukunft Bianca, Osmanodja Bilgin
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Clinic for Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
J Clin Med. 2023 Sep 21;12(18):6103. doi: 10.3390/jcm12186103.
Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. We analyzed COVID-19 incidence and clinical outcomes in a single-center cohort of approximately 2500 KTRs. Between 1 February 2020 and 1 July 2022, 578 KTRs were infected with SARS-CoV-2, with 25 (4%) recurrent infections. In total, 208 KTRs (36%) were hospitalized, and 39 (7%) died. Among vaccinated patients, infection with the Omicron variant had a mortality of 2%. Unvaccinated patients infected with the Omicron variant showed mortality (9% vs. 11%) and morbidity (hospitalization 52% vs. 54%, ICU admission 12% vs. 18%) comparable to the pre-Omicron era. Multivariable analysis revealed that being unvaccinated (OR = 2.15, 95% CI [1.38, 3.35]), infection in the pre-Omicron era (OR = 3.06, 95% CI [1.92, 4.87]), and higher patient age (OR = 1.04, 95% CI [1.03, 1.06]) are independent risk factors for COVID-19 hospitalization, whereas a steroid-free immunosuppressive regimen was found to reduce the risk of COVID-19 hospitalization (OR = 0.51, 95% CI [0.33, 0.79]). This suggests that both virological changes in the Omicron variant and vaccination reduce the risk for morbidity and mortality from COVID-19 in KTRs. Our data extend the knowledge from the general population to KTRs and provide important insights into outcomes during the Omicron era.
肾移植受者（KTRs）感染新型冠状病毒肺炎（COVID-19）后的发病率和死亡率高于普通人群，且对疫苗接种的反应受损。我们分析了一个约2500名KTRs的单中心队列中的COVID-19发病率和临床结局。在2020年2月1日至2022年7月1日期间，578名KTRs感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2），其中25例（4%）为复发性感染。共有208名KTRs（36%）住院，39例（7%）死亡。在接种疫苗的患者中，感染奥密克戎变异株的死亡率为2%。未接种疫苗且感染奥密克戎变异株的患者的死亡率（9%对11%）和发病率（住院率52%对54%，重症监护病房（ICU）入住率12%对18%）与奥密克戎变异株出现之前的时代相当。多变量分析显示，未接种疫苗（比值比（OR）=2.15，95%置信区间（CI）[1.38，3.35]）、在奥密克戎变异株出现之前的时代感染（OR = 3.06，95% CI [1.92，4.87]）以及患者年龄较大（OR = 1.04，95% CI [1.03，1.06]）是COVID-19住院的独立危险因素，而无类固醇免疫抑制方案可降低COVID-19住院风险（OR = 0.51，95% CI [0.33，0.79]）。这表明奥密克戎变异株的病毒学变化和疫苗接种均可降低KTRs感染COVID-19后的发病和死亡风险。我们的数据将普通人群的知识扩展到了KTRs，并为奥密克戎时代的结局提供了重要见解。
