COVID-19 among Kidney Transplant Recipients: Evaluating Risk Factors During the Initial Phase of the Pandemic
Alexandra Nowak, Aurora Caldinelli, Mårten Segelmark, Helena Rydell, Angelica Artborg, Rino Bellocco, Maria Stendahl, Bengt Lindholm, Julia Wijkström, Marie Evans
doi:10.1093/ckj/sfaf030/7989457
Background. Current knowledge about risk factors for severe COVID-19 among kidney transplant recipients stem from meta-analyses of small or regional studies. Methods. All kidney transplant recipients in Sweden as of January 1, 2020 (n=5,824) were followed during the first two years of the pandemic. Data from the Swedish Renal Registry and linked health care registries were analysed by multivariable adjusted logistic regression to identify risk factors for severe COVID-19, defined as hospitalization or death due to COVID-19. Results. Male sex increased the risk of severe COVID-19. While many comorbidities were associated with increased risk, their significance diminished after adjustment for other factors. Kidney transplant recipients of working age, 49-58 years adjusted odds ratio (aOR) 2.32 (95% CI
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"abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>Current knowledge about risk factors for severe COVID-19 among kidney transplant recipients stem from meta-analyses of small or regional studies.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>All kidney transplant recipients in Sweden as of January 1, 2020 (n = 5 824) were followed during the first two years of the pandemic. Data from the Swedish Renal Registry and linked health care registries were analysed by multivariable adjusted logistic regression to identify risk factors for severe COVID-19, defined as hospitalization or death due to COVID-19.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>Male sex increased the risk of severe COVID-19. While many comorbidities were associated with increased risk, their significance diminished after adjustment for other factors. Kidney transplant recipients of working age, 49–58 years adjusted odds ratio (aOR) 2.32 (95% CI 1.53–3.51) and 59–68 years aOR (1.92; 1.26–2.91) had the highest risk compared to the youngest age group (18–38 years). Compared to recently (&lt;1 year) transplanted patients, those transplanted more than 5 years ago had lower the risk of severe COVID-19 (aOR 0.52; 0.36–0.75 for 6–10 years; aOR 0.57; 0.41–0.79 for &gt; 10 years). Longer pre-transplant dialysis vintage (aOR1-year 1.04; 1.01–1.06) and deceased donor kidneys (aOR 1.41; 1.09–1.84) increased the risk. Immunosuppression with mycophenolate mofetil (aOR 1.47, 95% CI 1.08–1.99) and proton pump inhibitor use (aOR 1.58, 95% CI 1.24–2.01) was strongly associated with severe COVID-19.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>While kidney transplant recipients share risk factors with the general population, working age groups were at the highest risk- unlike in the general population. These findings emphasize the need for targeted prevention and treatment strategies for kidney transplant recipients in future pandemics.</jats:p>\n </jats:sec>",
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