Association of Inflammatory Biomarkers with Immunosuppression Management and Outcomes in Kidney Transplant Recipients with COVID-19

AbdulRahim, Nashila; McAdams, Meredith; Xu, Pin; Wojciechowski, David; Hoz, RicardoLa; Lu, Christopher; Vazquez, Miguel A.; Hedayati, S. Susan

INTRODUCTION: Kidney transplant recipients with COVID-19 are at increased risk for adverse outcomes, such as Acute Kidney Injury (AKI), Intensive Care Unit (ICU) admission, and death. The association of inflammatory biomarkers with outcomes and impact of changes in immunosuppression on biomarker levels are unknown. METHODS: We investigated factors associated with a composite of AKI, ICU admission, or death, and whether immunosuppression changes correlated with changes in inflammatory biomarkers and outcomes in kidney transplant recipients with a positive SARS-CoV2 PCR. RESULTS: Of 59 patients, 50% had eGFR<60 mL/min/1.73 m(2). Patients who discontinued calcineurin-inhibitors (CNI) had higher peak hsCRP than those who maintained the same dose, median (IQR) 344 (145-374) vs. 41 (22-116) mg/L, p=0.03. 73% were hospitalized, 22% had ICU admissions, and 20% died. 56% had AKI, of which 35% required dialysis. All with AKI but without pulmonary manifestations recovered to 10% of baseline creatinine. Factors associated with the composite outcome were eGFR<60, OR (95% CI)=5.833 (1.880-18.099), p=0.002, hsCRP, OR=1.011 per unit increase (1.002-1.021), p=0.019, WBC, OR=1.173 per unit increase (1.006-1.368), p=0.041, and having CNI decreased or discontinued, OR=4.286 (1.353-13.572), p=0.013. eGFR<60, OR=11.176 (1.581-79.001), p=0.016, and peak hsCRP, OR =1.010 per unit increase (1.000-1.020), p=0.049 remained associated with the composite in the multivariable model. CONCLUSIONS: Kidney transplant recipients with COVID-19 have high rates of ICU admissions, AKI, and death. Those with eGFR<60 are at highest risk. CNI reduction is associated with higher inflammatory biomarkers, correlating with worse outcomes. More studies are needed to determine if this association should drive clinical management.