COVID‐19 in elderly kidney transplant recipients

Crespo, Marta; José Pérez‐Sáez, María; Redondo‐Pachón, Dolores; Llinà s‐Mallol, Laura; Montero, María Milagro; Villar, Judith; Arias‐Cabrales, Carlos; Buxeda, Anna; Burballa, Carla; Vázquez, Susana; López, Thais; Moreno, Fátima; Mir, Marisa; Outón, Sara; Sierra, Adriana; Collado, Silvia; Barrios, Clara; Rodríguez, Eva; Sans, Laia; Barbosa, Francesc; Cao, Higini; Arenas, María Dolores; Güerri‐Fernández, Roberto; Horcajada, Juan Pablo; Pascual, Julio

The SARS‐Cov‐2 infection disease (COVID‐19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March‐12(th) until April‐4(th) 2020, we diagnosed COVID‐19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti‐retroviral and tocilizumab. Short‐term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic and showed higher D‐dimer, C‐reactive protein, and IL‐6 at their first tests. COVID‐19 is frequent among the elderly KT population and associates a very early and high mortality rate.