Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study

Duo LV; Xishao XIE; Qinyun YANG; Zhimin CHEN; Guangjun LIU; Wenhan PENG; Rending WANG; Hongfeng HUANG; Jianghua CHEN; Jianyong WU

doi:10.1631/jzus.B2300538

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Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study

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Research Article | Updated：2024-06-24

Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study
Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study
在2019冠状病毒病暴发流行期间感染并住院治疗的肾移植受者的临床特征与预后：一项中国单中心队列研究
Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) Vol. 25, Issue 6, Pages: 529-540(2024)
Affiliations：

1.Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2.Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Hangzhou 310003, China
3.Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
4.Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou 310003, China
5.Institute of Nephrology, Zhejiang University, Hangzhou 310003, China
6.Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou 310003, China
7.The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310003, China
8.Information Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
Funds：
DOI：10.1631/jzus.B2300538
CLC：
CSTR：
Published： 15 June 2024 ，

Received： 31 July 2023 ，

Revised： 22 November 2023 ，

吕朵,谢锡绍,杨钦云等.在2019冠状病毒病暴发流行期间感染并住院治疗的肾移植受者的临床特征与预后：一项中国单中心队列研究[J].浙江大学学报（英文版）（B辑：生物医学和生物技术）,2024,25(06):529-540.

Duo LV, Xishao XIE, Qinyun YANG, et al. Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study. [J]. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) 25(6):529-540(2024)
吕朵,谢锡绍,杨钦云等.在2019冠状病毒病暴发流行期间感染并住院治疗的肾移植受者的临床特征与预后：一项中国单中心队列研究[J].浙江大学学报（英文版）（B辑：生物医学和生物技术）,2024,25(06):529-540. DOI： 10.1631/jzus.B2300538.

Duo LV, Xishao XIE, Qinyun YANG, et al. Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study. [J]. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) 25(6):529-540(2024) DOI： 10.1631/jzus.B2300538.

摘要

2022年12月2019冠状病毒病（COVID-19）在中国出现短期的暴发流行，大量肾移植受者在感染COVID-19后需住院治疗。本研究回顾分析了在2022年12月16日至2023年1月31日期间感染COVID-19并在浙江大学医学院附属第一医院住院治疗的肾移植受者的临床特征和预后，随访截至2023年3月31日。本研究共纳入324名患者，其中位年龄为49岁，从出现症状到入院的中位时间为13天。分别有67例（20.7%）、11例（3.4%）和148例（45.7%）患者接受了莫那匹韦、阿兹夫定和奈玛特韦/利托那韦治疗，29例（9.0%）患者接受了多种抗病毒药物治疗，48例（14.8%）接受了托珠单抗治疗，53例（16.4%）接受了巴瑞替尼治疗。其中，81例（25.0%）发生急性肾损伤（AKI），39例（12.0%）转入ICU治疗，55例（17.0%）发生真菌感染，50例（15.4%）最终发生移植肾失功。患者的28天死亡率为9.0%，截至随访终点时共有42例（13.0%）患者死亡。多因素Cox回归分析显示合并脑血管疾病、AKI出现、白介素-6（IL-6）水平大于6.8 pg/mL、每日平均糖皮质激素剂量大于50 mg以及真菌感染等因素与住院患者死亡风险增加相关。结果表明，感染COVID-19后需住院治疗的肾移植受者死亡率很高。此外，服用免疫调节剂或过迟应用抗病毒药物，并不能提高患者生存率，而且大剂量的糖皮质激素使用则会增加死亡风险。

Abstract

Background

Following the short-term outbreak of coronavirus disease 2019 (COVID-19) in December 2022 in China

clinical data on kidney transplant recipients (KTRs) with COVID-19 are lacking.

Methods

We conducted a single-center retrospective study to describe the clinical features

complications

and mortality rates of hospitalized KTRs infected with COVID-19 between Dec. 16

2022 and Jan. 31

2023. The patients were followed up until Mar. 31

2023.

Results

A total of 324 KTRs with COVID-19 were included. The median age was 49 years. The median time between the onset of symptoms and admission was 13 d. Molnupiravir

azvudine

and nirmatrelvir/ritonavir were administered to 67 (20.7%)

11 (3.4%)

and 148 (45.7%) patients

respectively. Twenty-nine (9.0%) patients were treated with more than one antiviral agent. Forty-eight (14.8%) patients were treated with tocilizumab and 53 (16.4%) patients received baricitinib therapy. The acute kidney injury (AKI) occurred in 81 (25.0%) patients and 39 (12.0%) patients were admitted to intensive care units. Fungal infections were observed in 55 (17.0%) patients. Fifty (15.4%) patients lost their graft. The 28-d mortality rate of patients was 9.0% and 42 (13.0%) patients died by the end of follow-up. Multivariate Cox regression analysis identified that cerebrovascular disease

AKI incidence

interleukin (IL)‍-6 level of >6.8 pg/mL

daily dose of corticosteroids of >50 mg

and fungal infection were all associated with an increased risk of death for hospitalized patients.

Conclusions

Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality. The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival

while higher doses of corticosteroids may increase the death risk.

关键词

2019冠状病毒病（COVID-19）肾移植住院治疗死亡率

Keywords

Coronavirus disease 2019 (COVID-19)Kidney transplantHospitalizationMortality

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