Covid-19 in hospitalized kidney transplant recipients: analysis of the multicenter registry during the first wave of the pandemic in Chile

Abstract

Introduction: The severity of COVID-19 infection in kidney transplant patients has been well-documented. Objectives: This study aims to determine the epidemiological and clinical data and identify predictors of poor prognosis during the epidemic’s early stages. Material and methods: This is a national semi-prospective, multicenter study of subjects with functioning grafts who were infected during the first wave of the pandemic in Chile between March 1 and September 31, 2020. Results: during this period, we recorded the hospitalization of 97 adult patients throughout the entire national territory. The average age was 52.5 years, 62% men, 45% hypertensive, 11% coronary, 10% diabetic, and 5% with chronic obstructive pulmonary disease, with an average post-transplant follow-up of 7.2 years and an average previous renal function of 47.7ml/min/1.7m2 (CKD-EPI formula). Between the onset of symptoms and diagnosis, there was an average period of 4.8 days, with a predominance of cough (44%), dyspnea (42%), and fever (42%). 34% developed acute kidney injury, and 36% of them required dialysis support. The lethality was 30%, prevailing in those with multiple organ failure (80%) and those who required invasive mechanical ventilation (52%). In the multivariate analysis, the best predictors of mortality were older age (OR: 2.92) and living in a low-income commune (OR: 2.35). Conclusions: This national project of the Chilean Society of Nephrology provided valuable information for monitoring the epidemiological evolution of the pandemic. It also helped to propose priority vaccination strategies, adjust immunosuppressive therapy, and design logistical aspects