Observational Study of the Clinical Characteristics and Short-Term Outcomes of Kidney Transplant Recipients Diagnosed With COVID-19 Infection (SARS-CoV-2) Requiring Hospitalization in New Orleans

Sixto Giusti; Shai Chazin; Pradeep Vaitla; Kofi Atiemo; Mohammad Atari; Anil Paramesh; Hoonbae Jeon; Aldo Torres-Ortiz; Ravi Thimmisetty; Jorge Garces

doi:10.31486/toj.21.0008

Observational Study of the Clinical Characteristics and Short-Term Outcomes of Kidney Transplant Recipients Diagnosed With COVID-19 Infection (SARS-CoV-2) Requiring Hospitalization in New Orleans

Ochsner J. 2021 Winter;21(4):329-334. doi: 10.31486/toj.21.0008.

Authors

Sixto Giusti^{1

2}, Shai Chazin², Pradeep Vaitla³, Kofi Atiemo², Mohammad Atari¹, Anil Paramesh², Hoonbae Jeon², Aldo Torres-Ortiz⁴, Ravi Thimmisetty⁵, Jorge Garces^{5

6}

Affiliations

¹ Department of Medicine, Section of Nephrology and Hypertension, Tulane University School of Medicine, New Orleans, LA.
² Department of Surgery, Kidney and Pancreas Transplant Program, Tulane University School of Medicine, New Orleans, LA.
³ Department of Medicine, Section of Nephrology and Transplant, University of Mississippi Medical Center, Jackson, MS.
⁴ Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.
⁵ Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
⁶ The University of Queensland Faculty of Medicine, Ochsner Clinic Foundation, New Orleans, LA.

Abstract

Background: Kidney transplant recipients are at increased risk of severe disease and death caused by coronavirus disease 2019 (COVID-19) infection. The role of immunosuppressive medications in the clinical presentation, disease course, and outcomes is not well understood. Methods: We analyzed kidney transplant recipients diagnosed with COVID-19 and requiring hospitalization during the initial infection surge at 2 large transplant centers in New Orleans, Louisiana, between February 1, 2020 and April 30, 2020. Patient presentation, clinical course, kidney transplant function, and postdischarge details are included in this analysis. Results: Twenty-three kidney transplant recipients hospitalized with COVID-19 were included in the study. The majority of patients were Black (95.7%). Diabetes, hypertension, and obesity were present in more than 50% of the patients. The most common presenting symptom was fever, present in 52.2% of patients. All patients were managed with reduction in immunosuppression. Patients received azithromycin (60.9%), hydroxychloroquine (47.8%), remdesivir (8.7%), and intravenous methylprednisolone pulse (8.7%). The average length of stay was 4.5 days (range, 2-18 days). In this study population, 73.9% of the patients sustained acute kidney injury, with an average peak serum creatinine of 3.81 mg/dL. Twenty-six percent of the patients required renal replacement therapy. Seventy-seven percent of patients developed proteinuria (at least 1+ proteinuria on urinalysis). Of the patients in this population who required mechanical ventilation (39.1%), 77.8% died. Overall, 30.4% of patients died of COVID-19-related complications during admission. Of the 16 patients discharged, the average serum creatinine at discharge was 2.09 mg/dL compared with an average preadmission serum creatinine of 1.8 mg/dL. Conclusion: During the initial COVID-19 infection surge in New Orleans, we noted that kidney transplant recipients had initial symptoms similar to the general population. However, we recorded a higher incidence of acute kidney injury and death compared to nontransplant patients. Patients who required mechanical ventilation had a high mortality rate. Black patients are overrepresented in our study.

Keywords: Acute kidney injury; COVID-19; immunosuppression; mortality; transplant recipients.