Comparative incidence and outcomes of COVID‐19 in kidney or kidney‐pancreas transplant recipients versus kidney or kidney‐pancreas waitlisted patients: A single‐center study

  1. Carlos A. Q. Santos
  2. Yoona Rhee
  3. Edward F. Hollinger
  4. Oyedolamu K. Olaitan
  5. Erik Schadde
  6. Vasil Peev
  7. Samuel N. Saltzberg
  8. Martin Hertl

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Abstract

Background

COVID‐19 epidemiologic studies comparing immunosuppressed and immunocompetent patients may provide insight into the impact of immunosuppressants on outcomes.

Methods

In this retrospective cohort study, we assembled kidney or kidney‐pancreas transplant recipients who underwent transplant from January 1, 2010, to June 30, 2020, and kidney or kidney‐pancreas waitlisted patients who were ever on the waitlist from January 1, 2019, to June 30, 2020. We identified laboratory‐confirmed COVID‐19 until January 31, 2021, and tracked its outcomes by leveraging informatics infrastructure developed for an outcomes research network.

Results

COVID‐19 was identified in 62 of 887 kidney or kidney‐pancreas transplant recipients and 20 of 434 kidney or kidney‐pancreas waitlisted patients (7.0% vs. 4.6%, p  = .092). Of these patients with COVID‐19, hospitalization occurred in 48 of 62 transplant recipients and 8 of 20 waitlisted patients (77% vs. 40%, p  = .002); intensive care unit admission occurred in 18 of 62 transplant recipients and 2 of 20 waitlisted patients (29% vs. 10%, p  = .085); and 7 transplant recipients were mechanically ventilated and died, whereas no waitlisted patients were mechanically ventilated or died (11% vs. 0%, p  = .116).

Conclusions

Our study provides single‐center data and an informatics approach that can be used to inform the design of multicenter studies.

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  1. Version published to 10.1111/ctr.14362
  2. ScreenIT

    SciScore for 10.1101/2020.07.20.20157990: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol was approved by the Institutional Review Board of Rush University Medical Center.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    It however, has limitations. First, it is a single-center pilot study with low numbers, thereby making definitive conclusions difficult. However, it provides important preliminary data that can be used for power calculations to inform the design of multicenter studies. Second, the incidence proportions of COVID-19 identified for these patients represent minimum estimates since some cases of COVID-19 may have been identified outside of our healthcare system and missed by our electronic health record. However, minimum estimates are still useful as it provides the lowest possible incidence proportions for the populations of interest. Third, our findings may not be generalizable since it is a single-center study. However, it provides data that may inform the design of multicenter studies that may have more generalizable results. In summary, we found that the incidence proportion of COVID-19 in kidney or kidney-pancreas transplanted patients was similar to that of kidney or kidney-pancreas waitlisted patients, and that transplanted patients had numerically more occurrences of hospitalization, intensive care unit admission, mechanical ventilation or death compared to waitlisted patients. Tests for nonrandom associations did not show statistical significance, but definitive conclusions will require adequately powered multicenter studies. This study provides preliminary data that can be used for power calculations for multicenter studies.

    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.

    About SciScore

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  3. Version published to 10.1101/2020.07.20.20157990v1 on medRxiv