Is COVID‐19 infection more severe in kidney transplant recipients?
There are no studies which have compared the risk of severe COVID‐19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID‐19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Trans...
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| Veröffentlicht in: | American journal of transplantation 2021-03, Vol.21 (3), p.1295-1303 |
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| container_title | American journal of transplantation |
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| creator | Caillard, Sophie Chavarot, Nathalie Francois, Hélène Matignon, Marie Greze, Clarisse Kamar, Nassim Gatault, Philippe Thaunat, Olivier Legris, Tristan Frimat, Luc Westeel, Pierre F. Goutaudier, Valentin Jdidou, Mariam Snanoudj, Renaud Colosio, Charlotte Sicard, Antoine Bertrand, Dominique Mousson, Christiane Bamoulid, Jamal Masset, Christophe Thierry, Antoine Couzi, Lionel Chemouny, Jonathan M. Duveau, Agnes Moal, Valerie Blancho, Gilles Grimbert, Philippe Durrbach, Antoine Moulin, Bruno Anglicheau, Dany Ruch, Yvon Kaeuffer, Charlotte Benotmane, Ilies Solis, Morgane LeMeur, Yannick Hazzan, Marc Danion, Francois |
| description | There are no studies which have compared the risk of severe COVID‐19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID‐19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single‐center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID‐19 or mortality. Severe COVID‐19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30‐day cumulative incidence of severe COVID‐19 did not differ between KTR and nontransplant patients; however, 30‐day COVID‐19‐related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C‐reactive protein (CRP) were associated with severe COVID‐19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID‐19‐related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID‐19‐related mortality compared to nontransplant hospitalized patients.
The increased mortality risk observed for hospitalized kidney transplant recipients compared to matched nontransplant patients is primarily driven by altered kidney function. |
| doi_str_mv | 10.1111/ajt.16424 |
| format | Article |
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The increased mortality risk observed for hospitalized kidney transplant recipients compared to matched nontransplant patients is primarily driven by altered kidney function.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.16424</identifier><identifier>PMID: 33259686</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Age ; Aged ; Brief Communication ; Brief Communications ; Cardiovascular disease ; Cardiovascular diseases ; clinical research / practice ; Comorbidity ; COVID-19 ; COVID-19 - diagnosis ; COVID-19 - epidemiology ; Creatinine ; Diabetes mellitus ; Dyspnea ; Female ; Fever ; France - epidemiology ; glomerular filtration rate (GFR) ; Graft Rejection - epidemiology ; Graft Rejection - prevention & control ; Human health and pathology ; Humans ; Immunosuppression / methods ; Immunosuppression Therapy - methods ; Immunosuppressive Agents - therapeutic use ; immunosuppressive regimens ; Incidence ; infection and infectious agents ‐ viral ; infectious disease ; Infectious diseases ; Intensive Care Units ; kidney failure / injury ; Kidney Transplantation ; kidney transplantation / nephrology ; Kidney transplants ; Life Sciences ; Lymphopenia ; Male ; Mechanical ventilation ; Middle Aged ; Mortality ; Pandemics ; Propensity Score ; Registries ; Respiration ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Transplant Recipients - statistics & numerical data</subject><ispartof>American journal of transplantation, 2021-03, Vol.21 (3), p.1295-1303</ispartof><rights>2020 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2020 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><rights>2021 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5054-b335718676d94595df5b009afdf90a33787528bc655bda140257c21135f7148e3</citedby><cites>FETCH-LOGICAL-c5054-b335718676d94595df5b009afdf90a33787528bc655bda140257c21135f7148e3</cites><orcidid>0000-0002-0525-4291 ; 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We enrolled two groups of patients hospitalized for COVID‐19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single‐center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID‐19 or mortality. Severe COVID‐19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30‐day cumulative incidence of severe COVID‐19 did not differ between KTR and nontransplant patients; however, 30‐day COVID‐19‐related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C‐reactive protein (CRP) were associated with severe COVID‐19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID‐19‐related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID‐19‐related mortality compared to nontransplant hospitalized patients.
The increased mortality risk observed for hospitalized kidney transplant recipients compared to matched nontransplant patients is primarily driven by altered kidney function.</description><subject>Age</subject><subject>Aged</subject><subject>Brief Communication</subject><subject>Brief Communications</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>clinical research / practice</subject><subject>Comorbidity</subject><subject>COVID-19</subject><subject>COVID-19 - diagnosis</subject><subject>COVID-19 - epidemiology</subject><subject>Creatinine</subject><subject>Diabetes mellitus</subject><subject>Dyspnea</subject><subject>Female</subject><subject>Fever</subject><subject>France - epidemiology</subject><subject>glomerular filtration rate (GFR)</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - prevention & control</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Immunosuppression / methods</subject><subject>Immunosuppression Therapy - methods</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>immunosuppressive regimens</subject><subject>Incidence</subject><subject>infection and infectious agents ‐ viral</subject><subject>infectious disease</subject><subject>Infectious diseases</subject><subject>Intensive Care Units</subject><subject>kidney failure / injury</subject><subject>Kidney Transplantation</subject><subject>kidney transplantation / nephrology</subject><subject>Kidney transplants</subject><subject>Life Sciences</subject><subject>Lymphopenia</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Propensity Score</subject><subject>Registries</subject><subject>Respiration</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Severity of Illness Index</subject><subject>Transplant Recipients - statistics & numerical data</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctOAyEUhonReF_4AmYSN7po5c6w0TSt2pombtQtYWYYpU6ZCtOa7nwEn9EnEa3WSyKbQ-Dj_8_hB2APwTaK61iPmjbiFNMVsIk4hC2OKFld7gnbAFshjCBEAqd4HWwQgpnkKd8EvUFIule3g97r8wuSiXWlyRtbu2Rce5MEMzOxWJc82MKZedJ47cKk0q5JvMntxBrXhNMdsFbqKpjdz7oNbs7Prrv91vDqYtDtDFs5g4y2MkKYQCkXvJCUSVaULINQ6rIoJdSEiFQwnGY5ZywrNKIQM5FjFPsvBaKpIdvgZKE7mWZjU-TR3OtKTbwdaz9Xtbbq942z9-qunikhGKEojQJHC4H7P8_6naF6P4OxC4RSOUORPfw08_Xj1IRGjW3ITRWHN_U0KEw5xxLDD9mDP-ionnoXvyJSkkhOIMHf5rmvQ_CmXHaAoHrPUcUc1UeOkd3_OemS_AouAscL4MlWZv6_kupcXi8k3wCybKT1</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Caillard, Sophie</creator><creator>Chavarot, 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COVID‐19 infection more severe in kidney transplant recipients?</title><author>Caillard, Sophie ; Chavarot, Nathalie ; Francois, Hélène ; Matignon, Marie ; Greze, Clarisse ; Kamar, Nassim ; Gatault, Philippe ; Thaunat, Olivier ; Legris, Tristan ; Frimat, Luc ; Westeel, Pierre F. ; Goutaudier, Valentin ; Jdidou, Mariam ; Snanoudj, Renaud ; Colosio, Charlotte ; Sicard, Antoine ; Bertrand, Dominique ; Mousson, Christiane ; Bamoulid, Jamal ; Masset, Christophe ; Thierry, Antoine ; Couzi, Lionel ; Chemouny, Jonathan M. ; Duveau, Agnes ; Moal, Valerie ; Blancho, Gilles ; Grimbert, Philippe ; Durrbach, Antoine ; Moulin, Bruno ; Anglicheau, Dany ; Ruch, Yvon ; Kaeuffer, Charlotte ; Benotmane, Ilies ; Solis, Morgane ; LeMeur, Yannick ; Hazzan, Marc ; Danion, 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statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caillard, Sophie</creatorcontrib><creatorcontrib>Chavarot, Nathalie</creatorcontrib><creatorcontrib>Francois, Hélène</creatorcontrib><creatorcontrib>Matignon, Marie</creatorcontrib><creatorcontrib>Greze, Clarisse</creatorcontrib><creatorcontrib>Kamar, Nassim</creatorcontrib><creatorcontrib>Gatault, Philippe</creatorcontrib><creatorcontrib>Thaunat, Olivier</creatorcontrib><creatorcontrib>Legris, Tristan</creatorcontrib><creatorcontrib>Frimat, Luc</creatorcontrib><creatorcontrib>Westeel, Pierre F.</creatorcontrib><creatorcontrib>Goutaudier, Valentin</creatorcontrib><creatorcontrib>Jdidou, Mariam</creatorcontrib><creatorcontrib>Snanoudj, Renaud</creatorcontrib><creatorcontrib>Colosio, Charlotte</creatorcontrib><creatorcontrib>Sicard, Antoine</creatorcontrib><creatorcontrib>Bertrand, Dominique</creatorcontrib><creatorcontrib>Mousson, Christiane</creatorcontrib><creatorcontrib>Bamoulid, Jamal</creatorcontrib><creatorcontrib>Masset, Christophe</creatorcontrib><creatorcontrib>Thierry, Antoine</creatorcontrib><creatorcontrib>Couzi, Lionel</creatorcontrib><creatorcontrib>Chemouny, Jonathan M.</creatorcontrib><creatorcontrib>Duveau, Agnes</creatorcontrib><creatorcontrib>Moal, Valerie</creatorcontrib><creatorcontrib>Blancho, Gilles</creatorcontrib><creatorcontrib>Grimbert, Philippe</creatorcontrib><creatorcontrib>Durrbach, Antoine</creatorcontrib><creatorcontrib>Moulin, Bruno</creatorcontrib><creatorcontrib>Anglicheau, Dany</creatorcontrib><creatorcontrib>Ruch, Yvon</creatorcontrib><creatorcontrib>Kaeuffer, Charlotte</creatorcontrib><creatorcontrib>Benotmane, Ilies</creatorcontrib><creatorcontrib>Solis, Morgane</creatorcontrib><creatorcontrib>LeMeur, Yannick</creatorcontrib><creatorcontrib>Hazzan, Marc</creatorcontrib><creatorcontrib>Danion, Francois</creatorcontrib><creatorcontrib>French SOT COVID Registry</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caillard, Sophie</au><au>Chavarot, Nathalie</au><au>Francois, Hélène</au><au>Matignon, Marie</au><au>Greze, Clarisse</au><au>Kamar, Nassim</au><au>Gatault, Philippe</au><au>Thaunat, Olivier</au><au>Legris, Tristan</au><au>Frimat, Luc</au><au>Westeel, Pierre F.</au><au>Goutaudier, Valentin</au><au>Jdidou, Mariam</au><au>Snanoudj, Renaud</au><au>Colosio, Charlotte</au><au>Sicard, Antoine</au><au>Bertrand, Dominique</au><au>Mousson, Christiane</au><au>Bamoulid, Jamal</au><au>Masset, Christophe</au><au>Thierry, Antoine</au><au>Couzi, Lionel</au><au>Chemouny, Jonathan M.</au><au>Duveau, Agnes</au><au>Moal, Valerie</au><au>Blancho, Gilles</au><au>Grimbert, Philippe</au><au>Durrbach, Antoine</au><au>Moulin, Bruno</au><au>Anglicheau, Dany</au><au>Ruch, Yvon</au><au>Kaeuffer, Charlotte</au><au>Benotmane, Ilies</au><au>Solis, Morgane</au><au>LeMeur, Yannick</au><au>Hazzan, Marc</au><au>Danion, Francois</au><aucorp>French SOT COVID Registry</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is COVID‐19 infection more severe in kidney transplant recipients?</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2021-03</date><risdate>2021</risdate><volume>21</volume><issue>3</issue><spage>1295</spage><epage>1303</epage><pages>1295-1303</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>There are no studies which have compared the risk of severe COVID‐19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID‐19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single‐center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID‐19 or mortality. Severe COVID‐19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30‐day cumulative incidence of severe COVID‐19 did not differ between KTR and nontransplant patients; however, 30‐day COVID‐19‐related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C‐reactive protein (CRP) were associated with severe COVID‐19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID‐19‐related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID‐19‐related mortality compared to nontransplant hospitalized patients.
The increased mortality risk observed for hospitalized kidney transplant recipients compared to matched nontransplant patients is primarily driven by altered kidney function.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>33259686</pmid><doi>10.1111/ajt.16424</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0525-4291</orcidid><orcidid>https://orcid.org/0000-0002-6657-6235</orcidid><orcidid>https://orcid.org/0000-0001-7704-427X</orcidid><orcidid>https://orcid.org/0000-0003-0385-8726</orcidid><orcidid>https://orcid.org/0000-0001-6309-3986</orcidid><orcidid>https://orcid.org/0000-0001-5793-6174</orcidid><orcidid>https://orcid.org/0000-0002-8766-4859</orcidid><orcidid>https://orcid.org/0000-0001-6361-1392</orcidid><orcidid>https://orcid.org/0000-0002-3648-8963</orcidid><orcidid>https://orcid.org/0000-0002-7442-2164</orcidid><orcidid>https://orcid.org/0000-0002-9213-6196</orcidid><orcidid>https://orcid.org/0000-0001-8913-415X</orcidid><orcidid>https://orcid.org/0000-0001-9113-2479</orcidid><orcidid>https://orcid.org/0000-0003-1930-8964</orcidid><orcidid>https://orcid.org/0000-0003-0861-2506</orcidid><orcidid>https://orcid.org/0000-0003-1664-2879</orcidid><orcidid>https://orcid.org/0000-0002-9863-8840</orcidid><orcidid>https://orcid.org/0000-0003-0356-5069</orcidid><orcidid>https://orcid.org/0000-0002-8235-2864</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1600-6135 |
| ispartof | American journal of transplantation, 2021-03, Vol.21 (3), p.1295-1303 |
| issn | 1600-6135 1600-6143 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7753418 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Age Aged Brief Communication Brief Communications Cardiovascular disease Cardiovascular diseases clinical research / practice Comorbidity COVID-19 COVID-19 - diagnosis COVID-19 - epidemiology Creatinine Diabetes mellitus Dyspnea Female Fever France - epidemiology glomerular filtration rate (GFR) Graft Rejection - epidemiology Graft Rejection - prevention & control Human health and pathology Humans Immunosuppression / methods Immunosuppression Therapy - methods Immunosuppressive Agents - therapeutic use immunosuppressive regimens Incidence infection and infectious agents ‐ viral infectious disease Infectious diseases Intensive Care Units kidney failure / injury Kidney Transplantation kidney transplantation / nephrology Kidney transplants Life Sciences Lymphopenia Male Mechanical ventilation Middle Aged Mortality Pandemics Propensity Score Registries Respiration Retrospective Studies Risk Factors SARS-CoV-2 Severity of Illness Index Transplant Recipients - statistics & numerical data |
| title | Is COVID‐19 infection more severe in kidney transplant recipients? |
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