Böbrek Nakli Alıcılarında COVID-19 Deneyimi Retrospektif Çalışma

Year 2024, Volume: 13 Issue: 1, 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

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