Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.
Department of Infectious Diseases, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
Transpl Infect Dis. 2024 Feb;26(1):e14204. doi: 10.1111/tid.14204. Epub 2023 Nov 27.
Because COVID-19 has been associated with high lethality rates among kidney transplant recipients (KTR), but also with a severe disruption and delays in overall healthcare, this study aims to evaluate the excess mortality in the pandemic era among KTR in a high-volume Brazilian transplant center.
This study used data from a single center that provides follow-up on all its transplant recipients. The population of interest included all the patients who were transplanted between August 31, 1983 and December 31, 2022 and who were live from January 1, 2014. Using the "AutoRegressive Integrated Moving Average" forecasting algorithm, the expected mortality for the pandemic era (2020-2022) was modeled from the pre-pandemic era (2014-2019).
There were 12 077 KTRs at risk of dying in the entire observation period. In the pre-pandemic era, there were 21 deaths per 1000 patients at risk. In the pandemic era, there were 1429 observed deaths (rate of 47 deaths per 1000 patients at risk) versus the expected 587 deaths, resulting in an absolute number of 842 excess deaths, or an observed-to-expected ratio of 2.4, or an absolute rate of 26 deaths in excess per 1000 patients at risk. The excess deaths exhibited a temporal pattern mirroring that of the surges in new cases and lethality rates of COVID-19. COVID-19-related deaths drove 94% of excess mortality in the pandemic era.
In this large cohort of KTR under centralized follow-up, more than twofold excess mortality was primarily driven by COVID-19-related deaths, highlighting the vulnerability of this population to the most severe presentation of SARS-CoV-2 infection.
由于 COVID-19 导致肾移植受者（KTR）的死亡率很高，但也严重扰乱和延迟了整体医疗保健，因此本研究旨在评估高容量巴西移植中心在大流行期间 KTR 的超额死亡率。
本研究使用来自一个为所有移植受者提供随访的单一中心的数据。感兴趣的人群包括所有于 1983 年 8 月 31 日至 2022 年 12 月 31 日期间接受移植且自 2014 年 1 月 1 日起存活的患者。使用“自回归综合移动平均”预测算法，对大流行时期（2020-2022 年）的预期死亡率进行建模，预测方法是基于大流行前时期（2014-2019 年）。
在整个观察期内，有 12077 名 KTR 有死亡风险。在大流行前时期，每 1000 名患者中有 21 人死亡。在大流行时期，观察到 1429 例死亡（每 1000 名患者中有 47 例死亡），而预期死亡人数为 587 人，导致超额死亡人数为 842 人，或观察到的与预期的比值为 2.4，或每 1000 名患者中有 26 例超额死亡。超额死亡的时间模式与 COVID-19 新发病例和死亡率的激增相吻合。COVID-19 相关死亡导致大流行时期 94%的超额死亡。
在这个接受集中随访的大型 KTR 队列中，两倍以上的超额死亡率主要是由 COVID-19 相关死亡驱动的，这突出表明该人群对 SARS-CoV-2 感染的最严重表现非常脆弱。
