Predictors of severe COVID‐19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry

Villanego, Florentino; Mazuecos, Auxiliadora; Pérez‐Flores, Isabel M.; Moreso, Francesc; Andrés, Amado; Jiménez‐Martín, Carlos; Molina, María; Canal, Cristina; Sánchez‐Cámara, Luis A.; Zárraga, Sofía; Ruiz‐Fuentes, María del Carmen; Aladrén, María José; Melilli, Edoardo; López, Verónica; Sánchez‐Álvarez, Emilio; Crespo, Marta; Pascual, Julio

SARS‐CoV‐2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID‐19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID‐19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti‐COVID‐19 treatment in the second wave (July–December) than in the first one (March–June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post‐KT should be considered when selecting recipients for transplantation in the COVID‐19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.