Mortality Rates in Transplant Recipients and Transplantation Candidates in a High-prevalence COVID-19 Environment
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- Nizam Mamode
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Zubir Ahmed
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Gareth Jones
- Royal Free London NHS Foundation Trust, London, United Kingdom.
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- Neal Banga
- Royal Free London NHS Foundation Trust, London, United Kingdom.
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- Reza Motallebzadeh
- Royal Free London NHS Foundation Trust, London, United Kingdom.
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- Hannah Tolley
- NHS Blood and Transplant, Bristol, United Kingdom.
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- Steve Marks
- Great Ormond Street Hospital, London, United Kingdom.
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- Jelena Stojanovic
- Great Ormond Street Hospital, London, United Kingdom.
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- Muhammad A. Khurram
- Royal London Hospital, London, United Kingdom.
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- Raj Thuraisingham
- Royal London Hospital, London, United Kingdom.
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- Joyce Popoola
- St Georges University Hospital NHS Foundation Trust, London, United Kingdom.
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- Abbas Ghazanfar
- St Georges University Hospital NHS Foundation Trust, London, United Kingdom.
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- David Game
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Kiran Sran
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Frank J.M.F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
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- Gaetano Lucisano
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
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- Manish Sinha
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Jonathon Olsburgh
- Guys, Evelina and St Thomas NHS Foundation Trust, London, United Kingdom.
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- Michelle Willicombe
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
抄録
<jats:sec> <jats:title>Background.</jats:title> <jats:p>The risk of COVID-19 infection in transplant recipients (TRs) is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas TRs with those on the waiting list, following admission with COVID-19 in a high-prevalence region.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods.</jats:title> <jats:p>Audit data from all 6 London transplant centers were amalgamated. Demographic and laboratory data were collected and outcomes included mortality, intensive care (ITU) admission, and ventilation. Adult patients who had undergone a kidney or kidney/pancreas transplant, and those active on the transplant waiting list at the start of the pandemic were included.</jats:p> </jats:sec> <jats:sec> <jats:title>Results.</jats:title> <jats:p>One hundred twenty-one TRs and 52 waiting list patients (WL) were admitted to hospital with COVID-19. Thirty-six TR died (30%), while 14 WL patients died (27% <jats:italic toggle="yes">P</jats:italic> = 0.71). There was no difference in rates of admission to ITU or ventilation. Twenty-four percent of TR required renal replacement therapy, and 12% lost their grafts. Lymphocyte nadir and D-dimer peak showed no difference in those who did and did not die. No other comorbidities or demographic factors were associated with mortality, except for age (odds ratio of 4.3 [95% CI 1.8-10.2] for mortality if aged over 60 y) in TR.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions.</jats:title> <jats:p>TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era.</jats:p> </jats:sec>
収録刊行物
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- Transplantation
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Transplantation 105 (1), 212-215, 2020-11-13
Ovid Technologies (Wolters Kluwer Health)