COVID-19 Infection in Kidney Transplant Patients: An Italian One-Year Single-Center Experience

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Background: COVID-19 is a life-threatening infection among elderly, comorbid patients, or transplanted patients. Lombardy (Region of Italy), accounts for 786.324 cases as of April 21st, 2021. Methods: We retrospectively describe our single Centre experience in 82 adult kidney-transplant patients with COVID-19 infection during two pandemic outbreaks: 27 (first outbreak) and 65 (second). Results: Thirty-seven patients were hospitalized (HP) and 65 were home managed (HM). Infection presented with fever (80 %), cough (51 %) and dyspnea (33 %). HP were older (60±11vs 50±14 years, p=0,001), had more severe respiratory symptoms (dyspnea 62.1%, p<0.0001 - cough 67% p=0.008), and a longer length of disease (30±28 vs 21±10, p=0.04). Incidence of acute kidney injury (AKI) was 29.7% (p<0.0001). Steroid dosage was increased in 66% of patients, p=0.0003 while Calcineurin Inhibitors were reduced up to one third in 45% of cases, p<0.0001. Eleven patients died (13%). HM patients recovered completely without sequelae. In the overall cohort, AKI development (p=0.006 OR 50.4 CI 95% 3.0-836) and age (p=0.04 OR 1.1 CI 95% 1.0-1.2) were the most important factors influencing the probability of death during the infection. Conclusions: Although we report a relatively low incidence of infection (5.1 %) incidence of death is almost four times higher than in general population. Table 1: - patients characteristics before COVID-19 infection. Variable Number of patients (n) 82 Gender (n) (M/F) 54/28 Median age (years) 55 (46-46) Type of transplant, n (deceased donor/living donor) 65/17 Median transplant vintage (months) 118(39-229) Steroids; CyA-Tac; MMF-MPA; mTor inhibitors (n) 74; 18-63; 55; 6 iRAS therapy (n/%) 21/26 Relevant comorbid conditions N/% Hypertension 67/82 Diabetes 9/32.1 Heart diseases/peripheral vascular disease 18/22 Active Neoplasia 2/2 Previous Neoplasia 12/14.3 Median laboratory values s-Creatinine (mg/dL) 1.46(1.2-1.8) Hb (g/dl) 12.9(11.7-13.7) s-Albumin (g/dL) 4.2(3.9-4.5) Prot-U (g/24 h) 0.16(0.10-0.43)

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