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Effects of immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19
Gaetano Alfano; Francesca Damiano; Francesco Fontana; Camilla Ferri; Francesco Giaroni; Andrea Melluso; Martina Montani; Niccolo' Morisi; Jessica Plessi; Lorenzo Tei; Silvia Giovanella; Giulia Ligabue; Giacomo Mori; Giovanni Guaraldi; Riccardo Magistroni; Gianni Cappelli.
Afiliação
  • Gaetano Alfano; Policlinico of Modena
  • Francesca Damiano; Policlinico of Modena
  • Francesco Fontana; Azienda Ospedaliera Universitaria di Modena
  • Camilla Ferri; Policlinico of Modena
  • Francesco Giaroni; Policlinico of Modena
  • Andrea Melluso; Policlinico of Modena
  • Martina Montani; Policlinico of Modena
  • Niccolo' Morisi; Policlinico of Modena
  • Jessica Plessi; Policlinico of Modena
  • Lorenzo Tei; Policlinico of Modena
  • Silvia Giovanella; Policlinico of Modena
  • Giulia Ligabue; Policlinico of Modena
  • Giacomo Mori; Policlinico of Modena
  • Giovanni Guaraldi; Policlinico of Modena
  • Riccardo Magistroni; Policlinico of Modena
  • Gianni Cappelli; Policlinico of Modena
Preprint em Inglês | medRxiv | ID: ppmedrxiv-21258414
ABSTRACT
BackgroundKidney transplant recipients with COVID-19 are at high risk of poor outcome because of comorbidities and immunosuppression. The effects of immunosuppressive therapy reduction are unclear in patients with COVID-19. MethodsWe conducted a retrospective study on 45 consecutive kidney transplant recipients followed at the University Hospital of Modena who tested positive for COVID-19 by RT-PCR analysis. ResultsThe median age of patients was 56.1 (interquartile range, [IQR] 47.3-61.1) years with a predominance of male (64.4%). Kidney transplantation vintage was 10.1 (2.7-16) years, and more than half of patients (55.6%) was on triple immunosuppressive therapy. Early reduction of immunosuppression occurred in 62.8% of patients and included antimetabolite (88.8%) and calcineurin inhibitor withdrawal (22.2%). Of the 45 patients, 88.9% became symptomatic and 40% required hospitalization. Overall mortality was 17.8%. There were no differences in outcomes between full- and reduced-dose immunosuppressive therapy at the end of follow-up. One hospitalized patient experienced irreversible graft failure. There were no differences in serum creatinine level and proteinuria in non-hospitalized patients with COVID-19. Admitted patients had better kidney function after dismission (P=0.019). Risk factors for death were age (odds ratio [OR] 1.19; 95%CI 1.01-1.39), and duration of kidney transplant (OR 1.17; 95%CI 1.01-1.35). One kidney transplant recipient experienced symptomatic COVID-19 reinfection after primary infection and anti-SARS-CoV-2 mRNA vaccine. ConclusionsDespite the reduction of immunosuppression, COVID-19 affected survival of kidney transplant recipients with COVID-19. Age and duration of kidney transplant were independent predictors of death in COVID-19. Early kidney function was favorable in most survivors after COVID-19.
Licença
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Texto completo: Disponível Coleções: Preprints Base de dados: medRxiv Tipo de estudo: Cohort_studies / Experimental_studies / Estudo observacional / Estudo prognóstico Idioma: Inglês Ano de publicação: 2021 Tipo de documento: Preprint
Texto completo: Disponível Coleções: Preprints Base de dados: medRxiv Tipo de estudo: Cohort_studies / Experimental_studies / Estudo observacional / Estudo prognóstico Idioma: Inglês Ano de publicação: 2021 Tipo de documento: Preprint
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