Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

Table 1 Baseline characteristics, n (%)

Characteristics		ICU admission, n = 21	Non-ICU admission, n = 75	P value
Age at transplant (years)		54.7 ± 13.9	50.4 ± 15.2	0.68
Age at COVID-19 diagnosis (years)		59.5 ± 14.1	57.1 ± 14.4	0.97
Male		16 (76)	40 (53)	0.06
Nonwhite		4 (19)	20 (27)	0.50
Cause of ESKD	Diabetes mellitus	6 (28)	21 (28)	0.56
	Hypertension	4 (19)	9 (12)
	Glomerular disease	8 (38)	23 (31)
	Polycystic kidney disease	0	6 (8)
	Other	3 (14)	16 (21)
Living donor		3 (14)	28 (37)	0.04
Previous transplant		3 (14)	23 (31)	0.14
Maintenance immunosuppressive	Tacrolimus + Mycophenolic acid + prednisone	18 (86)	53 (71)	0.17
	Prednisone based immunosuppression	19 (91)	69 (91)	0.98
Vaccinated		11 (52)	44 (59)	0.61
Rejection within six months before COVID-19		0	2 (3)	0.45
Baseline serum creatinine before COVID-19 (mg/dL)		1.57 ± 0.73	1.89 ± 1.57	< 0.001
Baseline eGFR before COVID-19 (mL/m2)		53.7 ± 21.1	42.3 ± 19.5	0.61
The interval from transplant to the first COVID-19 (month)		58.5 ± 54.7	81.8 ± 68.4	0.26

COVID-19: Coronavirus disease 2019; eGFR: Estimated glomerular filtration rate; ICU: Intensive care unit; ESKD: End-stage kidney disease.

Table 2 Outcomes, n (%)

Characteristics	ICU admission	Non-ICU admission	P value
Respiratory symptoms for admission	15 (71)	49 (65)	0.6
Mean hospital length of stay (days)	21.8 ± 19.4	8.6 ± 9.8	< 0.001
Use of remdesivir for management of SARS-CoV-2	5 (24)	23 (31)	0.54
Serum creatinine at time of SARS-CoV-2 infection (mg/dL)	1.91 ± 0.25	2.50 ± 2.17	0.002
Serum eGFR at the time of SARS-CoV-2 infection (mL/m2)	48.1 ± 24.6	37.9 ± 21.1	0.34
Serum creatinine 1-month post SARS-CoV-2 infection (mg/dL)	1.22 ± 0.29 (n = 6)	1.86 ± 1.47 (n = 66)	0.12
Serum eGFR 1 month SARS-CoV-2 infection (mL/m2)	73 ± 30.7	46.4 ± 21.7	0.18
Serum creatinine 6 months post SARS-CoV-2 infection (mg/dL)	1.34 ± 0.62 (n = 5)	1.67 ± 0.72 (n = 62)	0.86
Serum eGFR 6 months SARS-CoV-2 infection (mL/m2)	67.0 ± 32.8	47.0 ± 19.5	0.07
Serum creatinine 1 year post SARS-CoV-2 infection (mg/dL)	1.32 ± 0.70 (n = 4)	1.93 ± 1.21 (n = 61)	0.39
Serum eGFR 1 year post SARS-CoV-2 infection (mL/m2)	70.3 ± 34.9	44.3 ± 20.8	0.09
Serum creatinine at last follow-up (mg/dL)	1.29 ± 0.84 (n = 4)	1.88 ± 1.30 (n = 53)	0.5
Serum eGFR at last follow-up (mL/m2)	76.8 ± 37.0	48.1 ± 21.9	0.1
Uncensored graft failure at last follow-up	17 (81)	23 (31)	< 0.001
Death at last follow-up	16 (76)	13 (17)	< 0.001
Death related to COVID-19	15 (71)	4 (5)	< 0.001

COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; eGFR: Estimated glomerular filtration rate; ICU: Intensive care unit.

Table 3 Risk factors for intensive care unit admission

Covariate	Univariate analyses			Multivariate analyses
	HR	95%CI	P value	HR	95%CI	P value
Age at SARS-CoV-2 infection diagnosis (per year)	1.01	0.98-1.05	0.35
Male recipient	3.29	1.10-9.88	0.03	3.11	1.04-9.34	0.04
Nonwhite recipient	0.71	0.24-2.13	0.55
Diabetes as a cause of ESKD vs other	1.09	0.42-2.83	0.86
Living donor recipient	0.35	0.10-1.19	0.09	0.38	0.11-1.30	0.12
Previous transplant	0.46	0.13-1.55	0.2
Tacrolimus + MPA + prednisone maintenance vs other	2.07	0.61-7.08	0.24
Prednisone based immunosuppression	0.89	0.21-3.82	0.87
Treatment of rejection before SARS-CoV-2 infection	--	--	--
Vaccinated	0.93	0.38-2.25	0.87
Baseline eGFR pre- SARS-CoV-2 infection (per mL/m2)	1.01	0.99-1.03	0.23
The interval from transplant to COVID-19 (per month)	0.99	0.98-1.01	0.4

COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; eGFR: Estimated glomerular filtration rate; ESKD: End-stage kidney disease; MPA: Mycophenolic acid.

Table 4 Risk for all-cause mortality

Covariate	Univariate analyses			Multivariate analyses
	HR	95%CI	P value	HR	95%CI	P value
ICU admission	10.2	4.72-21.9	< 0.001	11.2	5.11-24.5	< 0.001
Age at COVID-19 diagnosis (per year)	1.05	1.02-1.08	0.002	1.06	1.02-1.09	0.001
Male recipient	1.90	0.86-4.17	0.11
Nonwhite recipient	0.60	0.23-1.58	0.31
Diabetes as a cause of ESKD vs other	1.13	0.52-2.50	0.75
Living donor recipient	0.72	0.32-1.64	0.44
Previous transplant	0.66	0.27-1.61	0.36
Tacrolimus + MPA + prednisone maintenance vs other	1.18	0.51-2.78	0.69
Prednisone based immunosuppression	0.87	0.26-2.87	0.82
Treatment of rejection before SARS-CoV-2 infection	--	--	--
Vaccinated	0.81	0.39-1.69	0.58
Baseline eGFR (per mL/m2)	1.0	0.98-1.02	0.94
Interval from transplant to COVID-19 (per month)	1.0	0.99-1.01	0.73
Respiratory symptoms for hospital admission	1.22	0.55-2.68	0.63
Remdesivir for management of COVID	0.48	0.18-1.26	0.14

COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; eGFR: Estimated glomerular filtration rate; ICU: Intensive care unit; ESKD: End-stage kidney disease; MPA: Mycophenolic acid.

Table 5 Risk for coronavirus disease 2019-related mortality

Covariate	Univariate analyses			Multivariate analyses
	HR	95%CI	P value	HR	95%CI	P value
ICU admission	25.5	8.26-78.8	< 0.001	27.2	8.69-84.9	< 0.001
Age at SARS-CoV-2 infection diagnosis (per year)	1.04	0.99-1.07	0.06	1.04	1.0-1.08	0.04
Male recipient	1.75	0.66-4.59	0.26
Nonwhite recipient	0.54	0.16-1.85	0.33
Diabetes as a cause of ESKD vs other	0.66	0.22-1.99	0.46
Living donor recipient	0.68	0.25-1.90	0.47
Previous transplant	0.48	0.14-1.66	0.25
Tacrolimus + MPA + prednisone maintenance vs other	1.33	0.44-4.02	0.61
Prednisone based immunosuppression	0.52	0.15-1.77	0.30
Treatment of rejection before SARS-CoV-2 infection	--	--	--
Vaccinated	0.66	0.26-1.60	0.35
Baseline eGFR (per mL/m2)	1.01	0.99-1.03	0.27
Interval from transplant to SARS-CoV-2 infection (per month)	1.0	0.99-1.01	0.68
Respiratory symptoms for hospital admission	1.13	0.43-2.99	0.80
Remdesivir for management of COVID	0.62	0.21-1.88	0.40

COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; eGFR: Estimated glomerular filtration rate; ICU: Intensive care unit; ESKD: End-stage kidney disease; MPA: Mycophenolic acid.