Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients.

Crespo, Marta; Mazuecos, Auxiliadora; Rodrigo, Emilio; Gavela, Eva; Villanego, Florentino; Sánchez-Alvarez, Emilio; González-Monte, Esther; Jiménez-Martín, Carlos; Melilli, Edoardo; Diekman, Fritz; Zárraga, Sofía; Hernández, Domingo; Pascual, Julio

BACKGROUND COVID-19 pandemic has posed at risk the kidney transplant (KT) population. We describe clinical pictures, risk factors for death and chances to recovery in a large cohort of KT recipients with COVID-19. METHODS Inclusion in a Spanish prospectively filled registry was allowed for KT cases with confirmed COVID-19. Outcomes were assessed as in-hospital mortality or recovery. RESULTS The study population comprised 414 patients. Fever, respiratory symptoms and dyspnea were the most frequent COVID-19 related symptoms, and 81.4% of them had pneumonia. More than one-third of patients showed digestive symptoms at diagnosis, combinations of nausea, vomiting and diarrhea. Most patients were hospitalized, 12.1% in intensive-care units, and 17.6% needed ventilator support. Treatment for COVID-19 included frequently hydroxychloroquine, azithromycin, high dose steroids, lopinavir/ritonavir and tocilizumab. After a mean follow-up of 44 days, the fatality rate was 26.3%. Pneumonia without gastrointestinal symptoms was associated with a 36.3% mortality (Respiratory phenotype), and gastrointestinal symptoms without pneumonia with a 5.3% mortality (Gastrointestinal phenotype). The mixed pneumonia and gastrointestinal phenotype showed an intermediate mortality of 19.5% (Mixed phenotype). Multivariate Cox regression analysis showed that age and pneumonia were independently associated with death, while the gastrointestinal phenotype was associated with recovery. CONCLUSIONS COVID-19 is frequent among the KT population. Advanced age and pneumonia are the main clinical features associated with a high mortality rate. Gastrointestinal disease is associated with a more benign course and lower mortality.