RISK FACTORS FOR MORTALITY IN STABLE KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 IN THE SOUTH OF SPAIN

López, Verónica; Vázquez-Sánchez, Teresa; Casas, Cristina; Schuldt, Ruben; Alonso-Titos, Juana; Ruiz-Esteban, Pedro; Cabello, Mercedes; Hernández, Domingo

INTRODUCTION The Covid-19 pandemic has especially affected kidney transplant (KT) recipients, who are more vulnerable than the general population due to their immunosuppressive status and added comorbidities. PURPOSE To determine risk factors related to infection and mortality from Covid-19 in KT recipients. METHODS The study included 113 stable KT recipients who had PCR-confirmed COVID-19 infection between March 2020 and February 2021, from a total of 2150 KT recipients. Outcomes related to patient survival were analyzed. RESULTS The mean age of the patients was 56±14 years; 62% were men. The median time between KT and infection was 88 months (IQR: 39-155). 90% were on tacrolimus therapy and 81% on mycophenolate mofetil (MMF). The clinical presentation was pneumonia (51%), fever (54%), cough (55%), dyspnea (38%), lymphopenia (50%) and gastrointestinal symptoms (25%). 21% required intubation and ICU admission. 27 (25%) patients were asymptomatic. 9% received hydroxychloroquine therapy plus azithromycin, 11% tocilizumab, 3.7% lopinavir/ritonavir, 49% steroids, 0.9% remdesivir and 9.3% convalescent plasma. Immunosuppression was reduced in all symptomatic patients. 19 patients (17%) died. Cox univariate analysis showed that the factors significantly associated with death were patient age, the presence of pneumonia or lymphopenia, and elevated C-reactive protein on admission. CONCLUSIONS Mortality in KT recipients with Covid-19 is very high, more than for the general population. Risk factors are patient age, and the presence of pneumonia or lymphopenia, as well as a higher C-reactive protein level at the time of diagnosis.