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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2
Emily E Zona, Mina L Gibes, Asha S Jain, Jeannina A Smith, Jacqueline M Garonzik-Wang, Didier A Mandelbrot, Sandesh Parajuli
Emily E Zona, Mina L Gibes, Asha S Jain, Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
Jeannina A Smith, Department of Infectious Disease, University of Wisconsin Hospital and Clinics, Madison, WI 53705, United States
Jacqueline M Garonzik-Wang, Department of Surgery, University of Wisconsin, Madison, WI 53705, United States
Didier A Mandelbrot, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
Sandesh Parajuli, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
Author contributions: Zona EE was responsible for data collection, manuscript preparation, and editing; Gibes ML and Jain AS were responsible for data collection and editing; Smith JA, Garonzik-Wang J, and Mandelbrot DA were responsible for editing; Parajuli S was responsible for data collection, concept design, analysis, and manuscript preparation; All authors have read and approve the final manuscript.
Institutional review board statement: Tis study was approved by the University of Wisconsin School of Medicine and Public Health Institutional Review Board (IRB protocol number: 2014-1072-CR004). Tis study was in adherence to the Declaration of Helsinki. The clinical and research activities being reported were consistent with the Principles of the Declaration of Istanbul as outlined in “The Declaration of Istanbul on Organ Trafficking and Transplant Tourism.”
Informed consent statement: Due to the nature of the study, informed consent from the subject pertinent to this study was not obtained from the subject.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sandesh Parajuli, MD, Associate Professor, Staff Physician, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, 4175 MFCB1685, Highland Ave, Madison, WI 53705, United States. sparajuli@medicine.wisc.edu
Received: April 6, 2024
Revised: May 8, 2024
Accepted: June 5, 2024
Published online: June 25, 2024
Processing time: 78 Days and 13.4 Hours
BACKGROUND
Kidney transplant recipients (KTR) are at risk of severe coronavirus disease 2019 (COVID-19) disease and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We predicted that hospitalization for COVID-19 and subsequent admission to the intensive care unit (ICU) would yield worse outcomes in KTRs.
AIM
To investigate outcomes among KTRs hospitalized at our high-volume transplant center either on the general hospital floor or the ICU.
METHODS
We retrospectively describe all adult KTRs who were hospitalized at our center with their first SARS-CoV-2 infection between 04/2020 and 04/2022 and had at least 12 months follow-up (unless they experienced graft failure or death). The cohort was stratified by ICU admission. Outcomes of interest included risk factors for ICU admission and mortality, length of stay (LOS), respiratory symptoms at admission, all-cause graft failure at the last follow-up, and death related to COVID-19.
RESULTS
96 KTRs were hospitalized for SARS-COV-2 infection. 21 (22%) required ICU admission. The ICU group had longer hospital LOS (21.8 vs 8.6 days, P < 0.001) and were more likely to experience graft failure (81% vs 31%, P < 0.001). Of those admitted to the ICU, 76% had death at last-follow up, and 71% had death related to COVID-19. Risk factors for ICU admission included male sex (aHR: 3.11, 95%CI: 1.04-9.34; P = 0.04). Risk factors for all-cause mortality and COVID-19-related mortality included ICU admission and advanced age at SARS-CoV-2 diagnosis. Mortality was highest within a month of COVID-19 diagnosis, with the ICU group having increased risk of all-cause (aHR: 11.2, 95%CI: 5.11-24.5; P < 0.001) and COVID-19-related mortality (aHR: 27.2, 95%CI: 8.69-84.9; P < 0.001).
CONCLUSION
ICU admission conferred an increased risk of mortality, graft failure, and longer LOS. One-fifth of those hospitalized died of COVID-19, reflecting the impact of COVID-19-related morbidity and mortality among KTRs.
Core Tip: This retrospective study investigated risk factors and outcomes among kidney-only transplant recipients who were diagnosed with and hospitalized for severe acute respiratory syndrome coronavirus 2 infection at a large volume transplant center within the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Recipients were divided into two groups based on whether they were admitted and/or transferred to the intensive care unit (ICU) or the general care floors. Recipients admitted to the ICU had longer hospital length of stays, higher risk of graft failure, and higher all-cause and COVID-19-related mortality rates compared to the general care group. Male sex was a risk factor for ICU admission.
