Immunosuppression and Mortality in KT Recipients With COVID-19

The mortality risk from COVID-19 is increased in kidney transplant recipients. A. O. Gérard and colleagues conducted a study to examine the association between maintenance immunosuppressive drugs and 60-day mortality in kidney transplant recipients with COVID-19.

Results of the study were reported during an oral presentation at the 2022 American Transplant Congress. The presentation was titled Association Between Maintenance Immunosuppressive Regimens and COVID-19 Mortality in Kidney Transplant Recipients.

Data from all kidney transplant recipients with COVID-19 in the French Solid Organ Transplant COVID-19 registry from February 28, 2020, to December 30, 2020, were retrieved. Patients with missing data on immunosuppressive therapy were excluded (n=116). Logistic regression was used to assess associations between immunosuppressive drugs and death within 60 days of COVID-19 symptom onset, with all baseline characteristics considered to influence outcome or immunosuppressive regimen. False positive rate was controlled for using Benjamini-Hochberg correction; 40 multiple imputations were performed. An adjusted P value of <.05 was considered statistically significant.

The cohort included 1451 kidney transplant recipients with COVID-19. Median age was 58 years, and 66.4% (n=963) were female. The most common comorbidities were hypertension (81.9%, n=1188), diabetes (34.5%, n=501), and cardiovascular disease (29.5%, n=428). Median time since transplant was 71 months. Maintenance immunosuppression regimen included calcineurin inhibitors (89.2%, n=1295), antimetabolites (83%, n=1205), corticosteroids (75.4%, n=1094), mammalian target of rapamycin inhibitors (9.9%, n=144), and belatacept (4.0%, n=58).

Of the 1451 patients, 13.9% (n=201) died within 60 days of COVID-19 symptom onset. Older age and baseline creatininemia were associated with mortality (odds ratio [OR], 1.09; 95% CI, 1.07-1.11 and OR, 1.01; 95% CI, 1.005-1.009, respectively; P<.001). There was an association between corticosteroid-free regimens and a significantly lower risk of death (OR, 0.48; 95% CI, 0.31-0.76; P=.011). There were no significant P values with all other variables.

“Corticosteroid-free regimens were associated with a lower risk of death in kidney transplant recipients with COVID-19,” the authors said. “While a short course of high-dose corticosteroids is beneficial in severely ill COVID-19 patients, prolonged maintenance corticosteroids expose to chronic immune disorders that may predispose kidney transplant recipients  to severe forms of COVID-19.”

Source: Gérard AO., Barbosa S, Anglicheau D, et al. Association between maintenance immunosuppressive regimens and COVID-19 mortality in kidney transplant recipients. Abstract of an oral presentation at the 2022 American Transplant Congress (Abstract 9026), Boston, Massachusetts, June 6, 2022.