COVID‐19 in elderly kidney transplant recipients

• Published in: American journal of transplantation Vol. 20; no. 10; pp. 2883 - 2889
• Main Authors: Crespo, Marta, Pérez‐Sáez, María J., Redondo‐Pachón, Dolores, Llinàs‐Mallol, Laura, Montero, María M., Villar‐García, Judith, Arias‐Cabrales, Carlos, Buxeda, Anna, Burballa, Carla, Vázquez, Susana, López, Thais, Moreno, Fátima, Mir, Marisa, Outón, Sara, Sierra, Adriana, Collado, Silvia, Barrios, Clara, Rodríguez, Eva, Sans, Laia, Barbosa, Francesc, Cao, Higini, Arenas, María D., Güerri‐Fernández, Roberto, Horcajada, Juan P., Pascual, Julio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.10.2020; John Wiley and Sons Inc
• Subjects: Aged; Antibiotics; Azithromycin; Betacoronavirus; Brief Communication; Brief Communications; clinical research/practice; Coronary artery disease; Coronavirus Infections - epidemiology; COVID-19; Disease Transmission, Infectious - statistics & numerical data; Fatalities; Female; Fever; Follow-Up Studies; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Heart diseases; Hospitalization - trends; Humans; Hydroxychloroquine; Incidence; infection and infectious agents – viral; Infections; Kidney Transplantation; kidney transplantation/nephrology; Kidney transplants; Lymphopenia; Male; Monoclonal antibodies; Mycophenolic acid; Pandemics; patient survival; Pneumonia, Viral - epidemiology; Renal function; Respiration; Retrospective Studies; Risk Assessment - methods; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Spain - epidemiology; Tacrolimus; Time Factors; TOR protein; Transplant Recipients - statistics & numerical data; Spain; patient survival; infection and infectious agents - viral; clinical research/practice; kidney transplantation/nephrology
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.16096

The SARS‐Cov‐2 infection disease (COVID‐19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March 12 until April 4, 2020, we diagnosed COVID‐19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti‐retroviral and tocilizumab. Short‐term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail, and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic, and showed higher D‐dimer, C‐reactive protein, and IL‐6 at their first tests. COVID‐19 is frequent among the elderly KT population and associates a very early and high mortality rate. The authors report early and high mortality rates for elderly kidney transplant recipients.