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COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic

BACKGROUND: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different ti...

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Autores principales: Demir, Erol, Ucar, Zuhal Atan, Dheir, Hamad, Danis, Ramazan, Yelken, Berna, Uyar, Murathan, Parmaksiz, Ergun, Artan, Ayse Serra, Sinangil, Ayse, Merhametsiz, Ozgur, Yadigar, Serap, Dirim, Ahmet Burak, Akin, Baris, Garayeva, Nurana, Safak, Seda, Turkmen, Aydin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097147/
https://www.ncbi.nlm.nih.gov/pubmed/35550025
http://dx.doi.org/10.1186/s12882-022-02784-w
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author Demir, Erol
Ucar, Zuhal Atan
Dheir, Hamad
Danis, Ramazan
Yelken, Berna
Uyar, Murathan
Parmaksiz, Ergun
Artan, Ayse Serra
Sinangil, Ayse
Merhametsiz, Ozgur
Yadigar, Serap
Dirim, Ahmet Burak
Akin, Baris
Garayeva, Nurana
Safak, Seda
Turkmen, Aydin
author_facet Demir, Erol
Ucar, Zuhal Atan
Dheir, Hamad
Danis, Ramazan
Yelken, Berna
Uyar, Murathan
Parmaksiz, Ergun
Artan, Ayse Serra
Sinangil, Ayse
Merhametsiz, Ozgur
Yadigar, Serap
Dirim, Ahmet Burak
Akin, Baris
Garayeva, Nurana
Safak, Seda
Turkmen, Aydin
author_sort Demir, Erol
collection PubMed
description BACKGROUND: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS: Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS: Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47–66]), first- (56 mL/min [IQR, 51–68]), third- (51 mL/min [IQR,48–67]) and sixth-months (52 mL/min [IQR, 48–81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS: Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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spelling pubmed-90971472022-05-12 COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic Demir, Erol Ucar, Zuhal Atan Dheir, Hamad Danis, Ramazan Yelken, Berna Uyar, Murathan Parmaksiz, Ergun Artan, Ayse Serra Sinangil, Ayse Merhametsiz, Ozgur Yadigar, Serap Dirim, Ahmet Burak Akin, Baris Garayeva, Nurana Safak, Seda Turkmen, Aydin BMC Nephrol Research BACKGROUND: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS: Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS: Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47–66]), first- (56 mL/min [IQR, 51–68]), third- (51 mL/min [IQR,48–67]) and sixth-months (52 mL/min [IQR, 48–81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS: Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode. BioMed Central 2022-05-12 /pmc/articles/PMC9097147/ /pubmed/35550025 http://dx.doi.org/10.1186/s12882-022-02784-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Demir, Erol
Ucar, Zuhal Atan
Dheir, Hamad
Danis, Ramazan
Yelken, Berna
Uyar, Murathan
Parmaksiz, Ergun
Artan, Ayse Serra
Sinangil, Ayse
Merhametsiz, Ozgur
Yadigar, Serap
Dirim, Ahmet Burak
Akin, Baris
Garayeva, Nurana
Safak, Seda
Turkmen, Aydin
COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title_full COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title_fullStr COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title_full_unstemmed COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title_short COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic
title_sort covid-19 in kidney transplant recipients: a multicenter experience from the first two waves of pandemic
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097147/
https://www.ncbi.nlm.nih.gov/pubmed/35550025
http://dx.doi.org/10.1186/s12882-022-02784-w
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