Mortality From COVID-19 Infection in Kidney Transplant Recipients Over Time

Yorg Al Azzi, MD, and colleagues at Montefiore Medical Center, Bronx, New York, conducted an analysis to examine the variation in mortality from SARS-CoV-2 infection in kidney transplant recipients during the course of the pandemic. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2022 in a poster titled Decreased Mortality From SARS-CoV-2 in Kidney Transplant Recipients Over the Course of the Pandemic.

During the study period of March 16, 2020, to May 4, 2022, a total of 537 patients at the center were diagnosed with SARS-CoV-2 infection by reverse transcription polymerase chain reaction test. Of the 537 patients, 59% were male, median age was 58 years, 51.2% were Hispanic, and 29% were African American. Three-quarters (75.4%) had received a deceased-donor renal transplant and 55% received anti-thymocyte induction. Most of the patients were on triple immunosuppression (96% calcineurin inhibitors, 87% antimetabolite, and 99% on prednisone).

During the first peak of the pandemic (March 16-April 30, 2020), the mortality rate was 35% (n=47/128). The mortality rate significantly decreased to 11% (n=7/61) from May 1, 2020, to the end of December 2020 with social distancing and use of face masks. With the introduction of vaccines and monoclonal antibodies, the mortality rate further declined to 7.7% (n=10/129) between January 1, 2021, and November 5, 2021. When the Omicron variant and subvariants were predominant (November 6, 2021, to   May 4, 2022) the mortality rate was 5.5% (n=12/219).

Among the patients diagnosed during the Omicron predominant wave, 85.8% (n=188/219) had received two doses of COVID-19 vaccine and 37.4% (n=82/219) had received a third dose. After introduction of the use of monoclonal antibodies, 93 patients received a combination of casirivimab/ imdevimab during the period of the initial SARS-CoV-2 variants and sotrovimab then bebtelovimab during the time of dominance of Omicron and subvariants. Only one death occurred in the group that received monoclonal antibody treatment; that patient had been hospitalized for severe COVID-19.

There were 23 reinfections in the study cohort. Most of the reinfected patients had received at least two doses of COVID-19 vaccine; only five received a third dose. None of the patients who were reinfected required hospitalization or died.

In summary, the authors said, “Mortality from SARS-CoV-2 infection in kidney transplant recipients has significantly decreased over time. This could be explained by initial exposure to higher viral load due to lack of personal protection and social distancing. However, since the judicious use of monoclonal antibodies and vaccination, in addition to social distancing and use of face masks, the mortality in kidney transplant recipients has decreased over time.”

Source: Al Azzi Y, Liriano-Ward LE, Kapoor S, Ajaimy M, Akalin E, Pynadath CT. Decreased mortality from SARS-CoV-2 in kidney transplant recipients over the course of the pandemic. TH-PO945. Abstract of a poster presented during the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.