Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection among Kidney Transplant Recipients: A Large Single-Center Experience

Emily E Zona; Mina L Gibes; Asha S Jain; Juan S Danobeitia; Jacqueline Garonzik-Wang; Jeannina A Smith; Didier A Mandelbrot; Sandesh Parajuli

doi:10.1155/2024/7140548

Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection among Kidney Transplant Recipients: A Large Single-Center Experience

Crit Care Res Pract. 2024 May 2:2024:7140548. doi: 10.1155/2024/7140548. eCollection 2024.

Authors

Emily E Zona¹, Mina L Gibes¹, Asha S Jain¹, Juan S Danobeitia^{2

3}, Jacqueline Garonzik-Wang³, Jeannina A Smith⁴, Didier A Mandelbrot¹, Sandesh Parajuli¹

Affiliations

¹ Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA.
² Baylor University Medical Center, Dallas, Texas, USA.
³ Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Department of Infectious Disease, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.

Abstract

Background: Kidney transplant recipients (KTRs) are a vulnerable immunocompromised population at risk of severe COVID-19 disease and mortality after SARS-CoV-2 infection. We sought to characterize the post-infection sequelae in KTRs at our center.

Methods: We studied all adult KTRs (with a functioning allograft) who had their first episode of SARS-CoV-2 infection between 04/2020 and 04/2022. Outcomes of interest included risk factors for hospitalization, all-cause mortality, COVID-19-related mortality, and allograft failure.

Results: Of 979 KTRs with SARS-CoV-2 infection, 381 (39%) were hospitalized. In the multivariate analysis, risk factors for hospitalization included advanced age/year (HR: 1.03, 95% CI: 1.02-1.04), male sex (HR: 1.29, 95% CI: 1.04-1.60), non-white race (HR: 1.48, 95% CI: 1.17-1.88), and diabetes as a cause of ESKD (HR: 1.77, 95% CI: 1.41-2.21). SARS-CoV-2 Vaccination was associated with decreased risk of hospitalization (HR: 0.73, 95% CI: 0.59-0.90), all-cause mortality (HR: 0.52, 95% CI: 0.37-0.74), and COVID-19-related mortality (HR: 0.47, 95% CI: 0.31-0.71) in the univariate and multivariate analyses. Risk factors for both all-cause and COVID-19-related mortality in the multivariate analyses included advanced age, hospitalization, and respiratory symptoms for hospital admission. Furthermore, additional risk factors for all-cause mortality in the multivariate analysis included being a non-white recipient and diabetes as a cause of ESKD, with being a recipient of a living donor as protective.

Conclusions: Hospitalization due to COVID-19-associated symptoms is associated with increased mortality. Vaccination is a protective factor against hospitalization and mortality.