Effects of immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19

  1. Gaetano Alfano
  2. Francesca Damiano
  3. Francesco Fontana
  4. Camilla Ferri
  5. Francesco Giaroni
  6. Andrea Melluso
  7. Martina Montani
  8. Niccolò Morisi
  9. Lorenzo Tei
  10. Jessica Plessi
  11. Silvia Giovanella
  12. Giulia Ligabue
  13. Giacomo Mori
  14. Giovanni Guaraldi
  15. Riccardo Magistroni
  16. Gianni Cappelli

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Abstract

Background

Kidney transplant recipients with COVID-19 are at high risk of poor outcome because of comorbidities and immunosuppression. The effects of immunosuppressive therapy reduction are unclear in patients with COVID-19.

Methods

We conducted a retrospective study on 45 consecutive kidney transplant recipients followed at the University Hospital of Modena who tested positive for COVID-19 by RT-PCR analysis.

Results

The median age of patients was 56.1 (interquartile range, [IQR] 47.3-61.1) years with a predominance of male (64.4%). Kidney transplantation vintage was 10.1 (2.7-16) years, and more than half of patients (55.6%) was on triple immunosuppressive therapy. Early reduction of immunosuppression occurred in 62.8% of patients and included antimetabolite (88.8%) and calcineurin inhibitor withdrawal (22.2%).

Of the 45 patients, 88.9% became symptomatic and 40% required hospitalization. Overall mortality was 17.8%. There were no differences in outcomes between full- and reduced-dose immunosuppressive therapy at the end of follow-up. One hospitalized patient experienced irreversible graft failure. There were no differences in serum creatinine level and proteinuria in non-hospitalized patients with COVID-19. Admitted patients had better kidney function after dismission (P=0.019). Risk factors for death were age (odds ratio [OR]: 1.19; 95%CI: 1.01-1.39), and duration of kidney transplant (OR: 1.17; 95%CI: 1.01-1.35). One kidney transplant recipient experienced symptomatic COVID-19 reinfection after primary infection and anti-SARS-CoV-2 mRNA vaccine.

Conclusions

Despite the reduction of immunosuppression, COVID-19 affected survival of kidney transplant recipients with COVID-19. Age and duration of kidney transplant were independent predictors of death in COVID-19. Early kidney function was favorable in most survivors after COVID-19.

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  1. Version published to 10.1101/2021.06.06.21258414v3 on medRxiv
  2. Version published to 10.1101/2021.06.06.21258414v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.06.06.21258414: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study has been authorized by the local Ethical Committee of Emilia Romagna (n. 839/2020).
    Field Sample Permit: The study protocol complies with the guidelines for human studies and includes evidence that the research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using SPSS® statistical software.
    SPSS®
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of the study should be enunciated. It is a retrospective study, with small sample size and a short follow-up after COVID-19. The small number of patients in full- and reduced-dose of IST group may have reduced the probability to observe an underlying difference between these two groups. Furthermore, we cannot exclude that in some cases, reduction of the IST occurred after a short delay from the diagnosis of COVID-19. However, all patients with symptoms or at risk of contagious underwent nasal swab as fast as possible in an ambulatory setting.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  4. Version published to 10.1101/2021.06.06.21258414v1 on medRxiv