Is Covid‐19 infection more severe in kidney transplant recipients?

Caillard, Sophie; Chavarot, Nathalie; Francois, Hélène; Matignon, Marie; Greze, Clarisse; Kamar, Nassim; Gatault, Philippe; Thaunat, Olivier; Legris, Tristan; Frimat, Luc; Westeel, Pierre Francois; Goutaudier, Valentin; Snanoudj, Renaud; Colosio, Charlotte; Sicard, Antoine; Bertrand, Dominique; Mousson, Christiane; Bamoulid, Jamal; Masset, Christophe; Thierry, Antoine; Couzi, Lionel; Chemouny, Jonathan M.; Duveau, Agnes; Moal, Valerie; Blancho, Gilles; Grimbert, Philippe; Durrbach, Antoine; Moulin, Bruno; Anglicheau, Dany; Ruch, Yvon; Kaeuffer, Charlotte; Benotmane, Ilies; Solis, Morgane; Le Meur, Yannick; Hazzan, Marc; Danion, Francois

There are no studies which have compared the risk of severe Covid‐19 and related mortality between transplant recipients and non‐transplant patients. We enrolled two groups of patients hospitalized for Covid‐19, i.e., kidney transplant recipients from the French Registry of Solid Organ Transplant (n=306) and a single‐center cohort of non‐transplant patients (n=795). An analysis was performed among subgroups matched for age and risk factors for severe Covid‐19 or mortality. Severe Covid‐19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death.Transplant recipients were younger and had more comorbidities compared to non‐transplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30‐day cumulative incidence of severe Covid‐19 did not differ between KTR and non‐transplant patients; however, 30‐day Covid‐19‐related mortality was significantly higher in KTR (17.9% versus 11.4%, respectively, p=0.038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C‐reactive protein (CRP) were associated with severe Covid‐19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR=1.55), and creatinine level >115 µmol/L (HR=2.32) were associated with Covid‐19‐related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. Kidney transplant recipients had a higher Covid‐19‐related mortality compared to non‐transplant hospitalized patients.