Introduction
The 2019 Covid-19 pandemia has been a big challenge for humanity, but especially for kidney transplant patients, given their chronic immunosuppression condition. These patients may have a worse prognosis than the general population. In Chile, more than half a million people have been infected by Covid-19, with a case fatality rate of 2.7%.
Our aim was to know the incidence, epidemiology, clinical behavior and predictive factors of poor outcomes in kidney-transplanted patients infected in Chile, making a comparative analysis with the general population and others replacement therapies patients.
Methods
Observational, prospective and multicenter study recording epidemiological, clinical and laboratory variables. Study covered from March 03 to September 30th (2020) including 4305 transplanted patients with functioning kidneys. Patients of all ages, diagnosed by rtPCR, serology or imaging, from public and private centers, were included The infection, case-fatality and mortality rates were analyzed and compared with other replacement therapies patients and general population.
Results
We registered 196 cases, 91% diagnosed by rtPCR; 13% was hospital-acquired. The average age was 49 years, 54% male, and transplants were performed a mean of 6.9 years before (0.1 - 38.9). The most common symptoms were fever (52%), cough (50%), myalgia (12%), headache (7%), dyspnea (22%) and gastrointestinal manifestations (21%); 11% asymptomatic patients. The median time from illness onset to diagnosis was 4.5 ± 2.9 days. 52% requiered hospitalization, mainly in older age, male sex, gastrointestinal symptoms, dyspnea, coronary heart disease and worse baseline renal function at admission. The hospitalization averaged 13 days (1-63), 35% required invasive mechanical ventilation and 34% suffered AKIN (1/3 replacement therapy). Overall mortality was 15.4%, rising to 30% in hospitalized patients and 50% for those requiring invasive mechanical ventilation. Six patients experienced graft lost. The multivariable analysis revealed as significant predictors of mortality the age (OR 2.92) and residence in lower-income districts (OR 2.35).
Transplants performed between January 1st and August 31st 2020 were 109; 13% were Covid-19 infected with a case-fatality rate of 28.6%. The contagion and mortality rates were significantly higher in this group than in those transplanted previously (2.96 and 5.92 times respectively), however the case-fatality was not different.
Compared with the general population, the incidence of infection in transplanted patients was 1.91, case-fatality 5.56 and mortality 10.64 times higher. Compared with patients on hemodialysis, mortality was significantly lower (RR 0.31) although the case-fatality rate did not reach statistical difference.
Conclusions
Covid-19-infected kidney transplanted patients have a higher case-fatality rate than the general population, being higher in hospitalized or recently transplanted. Higher mortality of patients residing in lower-income districts confirms the syndemic nature of this disease. Although the mortality and infection rate of transplanted patients with Covid-19 is higher than the general population, it is not significantly lower than the case-fatality rates in other RRT. The high mortality found in recently transplanted patients makes it necessary to analyze transplantation policies, considering the high risk of contagion and poor outcomes.
No conflict of interest