RESUMO
Background: Kidney transplant recipients (KT) are a vulnerable population with a risk of death after COVID-19 infection (COV-I) four times higher than in the general population. mRNA COVID-19 vaccines changed the prognosis. Although KT have an impaired immunological response to mRNA vaccines, in March 2021 we started a vaccination campaign. Method(s): Among 1611 KT, 72 (4.2%) had COV-I (positive molecular nasopharyngeal swab) between 31 October 2021 and 15 January 2022 (3rd outbreak). Fourty-one (57%) were male and 58 (80.5%) had a deceased donor transplant, median age was 52 (43-60) years, median transplant vintage 57 (27-159) months, median serum creatinine 1.37 (1.0-1.7) mg/dL. KT were on calcineurin inhibitors, prednisone, mycophenolate (MMF) and mTOR inhibitors in 93-87-79% and 5.6% respectively. At COV-I 43 KT had received 3 doses of Comirnaty (BNT162b2), 21 two and 4 one, 4 were not vaccinated. DELTA variant was present in 36. Treatment included: increase of the daily steroid dosage (69%), MMF withdrawal (70%) or halving (5%) and monoclonal antibodies: Ronapreve or Xevudy (32%). Nine delta positive KT were hospitalized for severe respiratory distress: 2 died (6.6%). Result(s): The variables associated with an increased risk for hospitalization were older age and dyspnea (p=0.023, p<0.0001 respectively). At multivariate analysis, dyspnea (p <0.0001) and MMF (p=0.003) were independently associated with the risk for hospitalization. Combination of the two variables increased the significance (p<0.0001). Comparing this series to the 82/1503 (5.4%) KT infected during the previous waves, hospitalization, mortality and cumulative mortality rates dropped from 45%, 29.3% and 13.4% to 30%, 6.6% and 2.7% respectively, main difference being the absence of vaccination in the first group. Conclusion(s): Vaccinations did not reduce the incidence of COV-I among KT but provided certain protection associated with a significantly better outcome.
RESUMO
Background: Immunomodulatory and anti-inflammatory properties have been hypothesized for native vitamin D (nVD). Very little is reported about nVD and risk of Sars-CoV-2 infection (COV) in renal transplant (RTx). In a cohort of renal transplanted patients (RTxp) we retrospectively evaluated: a) nVD status in patients with (COV+) and without (COV-) COV infection;b) the impact of nVD status on severity of COV. Methods: The study includes 61 COV+ in whom nVD status was available in the year before the infection, and 122 COV-matched 1:2 for age (53[45-64]years), gender (M=60.7%), RTx vintage (7[2-15]years), presence of diabetes (18%), arterial hypertension (85%) and cardiac symptomatic disease (3%). Renal function, 24-h proteinuria, mineral metabolism (MM) parameters were evaluated at 1, 6 and 12 months before COV whereas nVD status was considered as the mean 25-OH-VD levels at the same timepoints. Severity of COV was based on the need for hospitalization (HOSP+: 27/61, 44.3%) and death (D+: 6/61, 9.8%). Results: a) nVD levels were significantly lower in COV+ than in COV-(19 [12-26] ng/mL and 23[16-30] ng/mL, respectively, p=0.01). No differences in the other biochemical parameters were found. The COV discriminative power of nVD status was evaluated by ROC curve (AUC 0.61, 95% CI 0.54-0.68, p=0.01), with a value of 25-OHVD 23.9 ng/mL showing the best discriminative power (sensibility 72%, specificity 47%). b) nVD levels showed a trend towards lower values in HOSP+COV+ than HOSPCOV+ (17[8-25] ng/mL vs 20[14-26] ng/mL) and in D+COV+ than D-COV+ (13 [6-23] ng/mL vs 20[13-26] ng/mL), although these differences did not reach the statistical significance (p=0.1 and p=0.2, respectively). Conclusions: With the limitations of the retrospective nature of the study and the small sample size, our data report that: a) COV+ showed lower nVD levels in the year preceding the infection compared to controls with similar main demographic features and comorbid conditions;b) No differences were found in renal function, proteinuria, and other MM parameters between the two groups;c) No association was found between nVD levels in the year preceding the infection and COV severity.