Abstract
Background
Following the short-term outbreak of Coronavirus disease 2019 (COVID-19) in December 2022 in China, clinical data on kidney transplant recipients (KTRs) with COVID-19 are lacking.
Methods
We conducted a single-center retrospective study to describe the clinical features, complications, and mortality rates of hospitalized KTRs infected with COVID-19 between Dec. 16, 2022 and Jan. 31, 2023. The patients were followed up until Mar. 31, 2023.
Results
A total of 324 KTRs with COVID-19 were included. The median age was 49 years. The median time between the onset of symptoms and admission was 13 d. Molnupiravir, azvudine, and nirmatrelvir/ritonavir were administered to 67 (20.7%), 11 (3.4%), and 148 (45.7%) patients, respectively. Twenty-nine (9.0%) patients were treated with more than one antiviral agent. Forty-eight (14.8%) patients were treated with tocilizumab and 53 (16.4%) patients received baricitinib therapy. The acute kidney injury (AKI) occurred in 81 (25.0%) patients and 39 (12.0%) patients were admitted to intensive care units. Fungal infections were observed in 55 (17.0%) patients. Fifty (15.4%) patients lost their graft. The 28-d mortality rate of patients was 9.0% and 42 (13.0%) patients died by the end of follow-up. Multivariate Cox regression analysis identified that cerebrovascular disease, AKI incidence, interleukin (IL)-6 level of >6.8 pg/mL, daily dose of corticosteroids of >50 mg, and fungal infection were all associated with an increased risk of death for hospitalized patients.
Conclusions
Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality. The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival, while higher doses of corticosteroids may increase the death risk.
摘要
2022 年 12 月 2019 冠状病毒病 (COVID-19) 在**出现短期的暴发流行, 大量肾移植受者在感染 COVID-19 后需住院治疗. 本研究回顾分析了在 2022 年 12 月 16 日至 2023 年 1 月 31 日期间感染 COVID-19 并在浙江大学医学院附属第一医院住院治疗的肾移植受者的临床特征和预后, 随访截至 2023 年 3 月 31 日. 本研究共纳入 324 名患者, 其中位年龄为 49 岁, 从出现症状到入院的中位时间为 13 天. 分别有 67 例 (20.7%)、 11 例 (3.4%) 和 148 例 (45.7%) 患者接受了莫那匹韦、 阿兹夫定和奈玛特韦/利托那韦治疗, 29 例 (9.0%) 患者接受了多种抗病毒药物治疗, 48 例 (14.8%) 接受了托珠单抗治疗, 53 例 (16.4%) 接受了巴瑞替尼治疗. 其中, 81 例 (25.0%) 发生急性肾损伤 (AKI), 39 例 (12.0%) 转入 ICU 治疗, 55 例 (17.0%) 发生真菌感染, 50 例 (15.4%) 最终发生移植肾失功. 患者的 28 天死亡率为 9.0%, 截至随访终点时共有 42 例 (13.0%) 患者死亡. 多因素 Cox 回归分析显示合并脑血管疾病、 AKI 出现、 白介素-6 (IL-6) 水**大于 6.8 pg/mL、 每日**均糖皮质激素剂量大于 50 mg 以及真菌感染等因素与住院患者死亡风险增加相关. 结果表明, 感染 COVID-19 后需住院治疗的肾移植受者死亡率很高. 此外, 服用免疫调节剂或过迟应用抗病毒药物, 并不能提高患者生存率, 而且大剂量的糖皮质激素使用则会增加死亡风险.
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Data availability statement
The data used or analyzed during this study can be available from the corresponding author on reasonable request.
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Acknowledgments
This work was supported by the National Natural Science Foundation of China (No. 2022YFC82200842) and the Zhejiang Provincial Natural Science Foundation of China (No. LQ22H050004).
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Research idea and study design: Duo LV, Jianyong WU, and Jianghua CHEN; Data acquisition: Duo LV, **shao XIE, Qinyun YANG, Zhimin CHEN, Guangjun LIU, Rending WANG, Wenhan PENG, and Hongfeng HUANG; Data analysis/interpretation and statistical analysis: Duo LV and **shao XIE; Supervision or mentorship: Jianyong WU and Jianghua CHEN. All the authors have read and approved the final manuscript, and therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Duo LV, **shao XIE, Qinyun YANG, Zhimin CHEN, Guangjun LIU, Wenhan PENG, Rending WANG, Hongfeng HUANG, Jianghua CHEN, and Jianyong WU declare that they have no conflicts of interest.
This study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital of Zhejiang University (expedition review No. 63 in 2023). The Ethics Committee authorized the informed consent waiver. This study was performed in accordance with the Declaration of Helsinki.
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Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study
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Lv, D., **e, X., Yang, Q. et al. Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study. J. Zhejiang Univ. Sci. B 25, 529–540 (2024). https://doi.org/10.1631/jzus.B2300538
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DOI: https://doi.org/10.1631/jzus.B2300538