Böbrek Nakli Alıcılarında COVID-19 Deneyimi Retrospektif Çalışma

Year 2024, , 24 - 31, 30.04.2024

Huseyin Celik , Mahmut Esat Danisoglu , Ender Hür , Murat Şamlı , Bulent Oktay , Soner Duman

https://doi.org/10.47493/abantmedj.1375704

Abstract

Amaç: Solid organ nakli olanlar, Koronavirüs Hastalığı-2019 (COVID-19) enfeksiyonlarına yatkın olabilir. Bu çalışmada COVİD-19 tanısı alan böbrek nakli alıcılarının sonuçlarının sunulması amaçlandı.

Yöntemler: Bu retrospektif kohort çalışmada, 1 Mart 2020 ile 31 Mart 2021 tarihleri arasında bir merkezden 95 böbrek nakli alıcısının dosyaları kullanıldı, 95'ine COVİD-19 tanısı konuldu. Hastalar hayatta kalanlar ve hayatta kalmayanlar olarak ayrıldı. İstatistiksel olarak student t testi yapıldı ve p<0.05 düzeyi anlamlı kabul edildi.

Bulgular: 95 hastanın 58'i (%61) erkek olup, yaş ortalaması 48,6±11,2 yıl, kadavra nakli yapılan 31 hasta (%32,6) vardır. Belirtiler olan ateş %31, öksürük %39, miyalji %59, ishal %20, genel olarak benzerdi; nefes darlığı hayatta kalanların %24'ünden olduğu halde hayatını kaybedenlerin tümünde mevcuttu (p<0.05).
Mortalite 12 (%12,6) idi. Ölenler daha yaşlıydı 55,89±6,99 ve 47,56±11,33 (p<0,05), vücut kitle indeksi daha yüksekti 28,8 ± 5,5 ve 25,5 ± 5,0 kg/m2 (p< 0,05), diyabet %50 ila 30 (p< 0.05) daha belirgindi. Ölenlerde hastanede kalış süresi 8.5±10.6 güne karşılık 3.05±5.93 gün (p< 0.01) daha uzundu.
Ölenlerde lökositoz 15,24±8,80 ve 7,13±3,39 (/mm3), karaciğer fonksiyon testleri ALT ve AST 632±1041 ve 2722±4662 ila 22,8±16,8 ve 23,3±12,6 (U/L) (p<0,001) , ferritin 2301,3±1349,1 ve 898,4±1007,6 (ng/ml) (p< 0,05), laktat dehidrojenaz 554±305 ve 252±130 (mg/dl) (p<0,001), prokalsitonin 1,310±1,285 ve 0,108±0,105 (ng/ml) (p<0,000) artmıştır. Tahmini glomerüler filtrasyon hızı düzeyleri 11.12±1.89'a karşılık 50.75±21.99 ml/dk (p<0.05) azalmıştır. Hayatta kalmayanların tümü ve hayatta kalanların %2'sinin hemodiyaliz ihtiyacı vardı. Kaplan Meier analizinde kadavra hastalarında sağkalım anlamlı olarak daha düşüktü (p<0.05).

Sonuç: COVİD-19'lu böbrek nakli alıcılarında akut böbrek hasarı ve mortalite oranı artmıştır, kadavradan nakilli hastaların sağkalımı daha düşük olmuştur.

Keywords

Akut böbrek hasarı, Coronavirüs-19 Hastalığı,, Böbrek nakli alıcıları

A Retrospective Study on Kidney Transplant Recipients Diagnosed with COVID-19

Abstract

Background and objective: Solid organ transplantation may prone to coronavirus disease-2019 (COVID-19) infections. It was aimed to present outcomes of kidney transplant recipients diagnosed with COVID-19.

Methods: In this retrospective cohort study was used 1034 kidney transplant recipients’ files from a center, 95 were diagnosed COVID-19 between March 1, 2020, and March 31, 2021. Patients were divided as survivors and non survivors. Statistically student t test was done and p<0.05 level was accepted as significant.

Results: In 95 patients, 58 (61%) were male with a mean age of 48.6±11.2 years, cadaveric transplantation 31 (32.6%). Symptoms were similar in overall; fever 31%, cough 39%, myalgia 59%, diarrhea 20%, but all non-survivor group having dyspnea than 24% of survivor group (p<0.05).
Mortality was 12 (12.6%), non-survivors were older 55.89±6.99 vs 47.56±11.33 years (p<0.05), body mass index higher 28.8 ± 5.5 vs 25.5 ± 5.0 kg/m2 (p< 0.05), diabetes more prominent 50 to 30% (p< 0.05), hospitalization were longer 8.5±10.6 vs 3.05±5.93 days (p< 0.01) in non-survivors.
In non-survivors’ leukocytosis 15.24±8.80 vs 7.13±3.39 (/mm3), increased liver function tests ALT and AST 632±1041 and 2722±4662 vs 22.8±16.8 and 23.3±12.6 (U/L) (p<0.001), ferritin 2301.3±1349.1 vs 898.4±1007.6 (ng/ml) (p< 0.05). Lactate dehydrogenase 554±305 vs 252±130 (mg/dl) (p<0.001), Procalcitonin 1.310±1.285 vs 0.108±0.105 (ng/ml) (p<0.000). estimated glomerular filtration rate levels decreased 11.12±1.89 vs 50.75±21.99 ml/min (p<0.05). All non-survivors and 2% of survivors needed hemodialysis. Survival was lower in cadaveric patients significantly in Kaplan Meier analysis (p<0.05).

Conclusion: Renal transplant recipients with COVID-19 have increased rate of acute kidney injury and mortality and survival was lower in cadaveric patients.

Keywords

Acute kidney injury, Coronavirus disease 2019, Renal transplantation recipients

References

• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
• Zhu L, Gong N, Liu B, et al. Coronavirus disease 2019 pneumonia in immunosuppressed renal transplant recipients: A summary of 10 confirmed cases in Wuhan, China. Eur Urol. 2020;77:748–754
• GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 709–733
• Akalin E, Azzi Y, Bartash R, et al. Covid-19 and kidney transplantation. N Engl J Med. 2020;382:2475–2477.
• Am J Transplant. 2020;20:3140–3148
• Crespo M, Mazuecos A, Rodrigo E, et al; Spanish Society of Nephrology COVID-19 Group. Respiratory and gastrointestinal COVID-19 phenotypes in kidney transplant recipients. Transplantation. 2020;104:2225–2233.
• Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934–943.
• Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
• Pujadas E, Chaudhry F, McBride R, et al. SARS-CoV-2 viral load predicts COVID-19 mortality. Lancet Respir Med. 2020;8:e70.
• Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847.
• Feldstein LR, Rose EB, Horwitz SM, et al; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–346.
• Bossini N, Alberici F, Delbarba E, et al. Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience. Am J Transplant. 2020. (Epub ahead of print. July 6, 2020). doi:10.1111/ajt.16176 56. Caillard S, Anglicheau D, Matignon M, et al. An initial report from the French SOT COVID Registry suggests high mortality due to Covid-19
• Caillard S, Anglicheau D, Matignon M, et al. An initial report from the French SOT COVID Registry suggests high mortality due to Covid-19 in recipients of kidney transplants. Kidney international. 2020;S0085- 2538(20)30961-3. doi:10.1016/j.kint.2020.08.005
• Demir E, Uyar M, Parmaksiz E, et al. COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul. Transpl Infect Dis. 2020:e13371 (Epub ahead of print. July 13, 2020). doi:10.1111/ tid.13371
• Elias M, Pievani D, Randoux C, et al. COVID-19 infection in kidney transplant recipients: Disease incidence and clinical outcomes. J Am Soc Nephrol. 2020;31:2413–2423.
• Fava A, Cucchiari D, Montero N, et al. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant. 2020. (Epub ahead of print. August 10, 2020). doi:10.1111/ajt.16246
• Sánchez-Álvarez JE, Pérez Fontán M, Jiménez Martín C, et al. SARSCoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN). Nefrologia. 2020;40:272–278.
• Benotmane I, Perrin P, Gautier Vargas G, et al. Biomarkers of cytokine release syndrome predict disease severity and mortality from COVID19 in kidney transplant recipients. Transplantation. 2020. (Epub ahead of print. September 30, 2020). doi:10.1097/TP.000000000 0003480
• Azzi, Yorg MD1; Bartash, Rachel MD2; Scalea, Joseph MD3; Loarte-Campos, Pablo MD1; Akalin, Enver MD, FAST, FASN1 COVID-19 and Solid Organ Transplantation: A Review Article, Transplantation: January 2021 - Volume 105 - Issue 1 - p 37-55 doi: 10.1097/TP.0000000000003523
• Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584:430–436.
• Chaudhry ZS, Williams JD, Vahia A, et al. Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A casecontrol study. Am J Transplant. 2020. (Epub ahead of print. July 12, 2020). doi:10.1111/ajt.16188
• Molnar MZ, Bhalla A, Azhar A, et al. Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States. Am J Transplant. 2020. (Epub ahead of print
• Fried MW, Crawford JM, Mospan AR, et al. Patient characteristics and outcomes of 11,721 patients with COVID19 hospitalized across the United States. Clin Infect Dis. 2020;ciaa1268. (Epub ahead of print. August 28, 2020). doi:10.1093/cid/ciaa1268
• Hoffmann M., Kleine-Weber H., Schroeder S., Krüger N., Herrler T., Erichsen S. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–280.e278. doi: 10.1016/j.cell.2020.02.052.
• Zou X., Chen K., Zou J.W., Han P.Y., Hao J., Han Z.G. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front. Med. 2020;14(2):185–192. doi: 10.1007/s11684-020-0754-0.
• Monteil V., Kwon H., Prado P., Hagelkrüys A., Wimmer R.A., Stahl M. Inhibition of SARS-CoV-2 infections in engineered human tissues using clinical-grade soluble human ACE2. Cell. 2020;181(4):905–913.e907. doi: 10.1016/j.cell.2020.04.004.
• Su H., Yang M., Wan C., Yi L.X., Tang F., Zhu H.Y. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219–227. doi: 10.1016/j.kint.2020.04.003.
• Peng L., Liu J., Xu W.X., Luo Q.M., Chen D.B., Lei Z.Y. SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens. J. Med. Virol. 2020 doi: 10.1002/jmv.25936.
• Wang W.L., Xu Y., Gao R., Lu R.J., Han K., Wu G.Z. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA J. Am. Med. Assoc. 2020;323(18) doi: 10.1001/jama.2020.3786.
• Wang K., Chen W., Zhou Y.S., Lian J.Q., Zhang Z., Du P. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. medRxiv. 2020 doi: 10.1101/2020.03.14.988345.
• Kosugi T., Maeda K., Sato W., Maruyama S., Kadomatsu K. CD147 (EMMPRIN/Basigin) in kidney diseases: from an inflammation and immune system viewpoint. Nephrol. Dial. Transplant. 2015;30(7):1097–1103. doi: 10.1093/ndt/gfu302.
• Poukkanen M., Vaara S.T., Pettila V., Kaukonen K.-M., Korhonen A.-M., Hovilehto S. Acute kidney injury in patients with severe sepsis in Finnish Intensive Care Units. Acta Anaesthesiol. Scand. 2013;57(7):863–872. doi: 10.1111/aas.12133.
• Prescott H.C., Girard T.D. Recovery from severe COVID-19 leveraging the lessons of survival from sepsis. JAMA. 2020 on 08/22/2020.
• Aslan A., van den Heuvel M.C., Stegeman C.A., Popa E.R., Leliveld A.M., Molema G. Kidney histopathology in lethal human sepsis. Crit. Care. 2018;22(1):359. doi: 10.1186/s13054-018-2287-3.
• Tisoncik J.R., Korth M.J., Simmons C.P., Farrar J., Martin T.R., Katze M.G. Into the eye of the cytokine storm. Microbiol. Mol. Biol. Rev. 2012;76(1):16–32. doi: 10.1128/MMBR.05015-11.
• David S., Inbal Z.L., Lori R., Shane R., Carl F.W., Garry A.N. Levels of the TNF-related cytokine LIGHT increase in hospitalized COVID-19 patients with cytokine release syndrome and ARDS. Clin. Sci. Epidemiol. 2020;5(4) doi: 10.1128/mSphere.00699-20.
• Darmon M., Clec'h C., Adrie C., Argaud L., Allaouchiche B., Azoulay E. Acute respiratory distress syndrome and risk of AKI among critically ill patients. Clin. J. Am. Soc. Nephrol. 2014;9(8):1347–1353. doi: 10.2215/CJN.08300813.
• Annat G., Viale J.P., Xuan B.B. Effect of PEEP ventilation on renal function, plasma renin, aldosterone, neurophysins and urinary ADH, and prostaglandins. Anesthesiology. 1983;582(2) doi: 10.1097/00000542-198302000-00006.