A Comparison Study of Coronavirus Disease 2019 Outcomes in Hospitalized Kidney Transplant Recipients

Abstract

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect any human host, but kidney transplant recipients (KTR) are considered more susceptible based on previous experience with other viral infections. We evaluated rates of hospital complications between SARS-CoV-2 positive KTR and comparator groups. Methods. We extracted data from the electronic health record on hospitalized patients with SARS-CoV-2 testing at six hospitals from March 4th through September 9th, 2020. We compared outcomes between SARS-CoV-2 positive KTR and controls: SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR and SARS-CoV-2 negative non-KTR. Results. Of 31,540 inpatients, 3213 tested positive for SARS-CoV-2. There were 32 SARS-CoV-2 positive and 224 SARS-CoV-2 negative KTR. SARS-CoV-2 positive KTR had higher ferritin levels [1412 (748,1749) vs. 553 (256,1035), p<0.01] compared to SARS-CoV-2 positive non-KTR. SARS-CoV-2 positive KTR had higher rates of ventilation (34% vs. 14%, p<0.01; vs. 9%, p<0.01; vs. 5%, p<0.01), vasopressor use (41% vs. 16%, p<0.01; vs. 17%, p<0.01; vs. 12%, p<0.01) and acute kidney injury (AKI) (47% vs. 15%, p<0.01; vs. 23%, p<0.01; vs. 10%, p<0.01) compared to SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR, and SARS-CoV-2 negative non-KTR, respectively. SARS-CoV-2 positive KTR continued to have increased odds of ventilation, vasopressor use and AKI compared to SARS-CoV-2 positive non-KTR independent of Elixhauser score, Black race and baseline eGFR. Mortality was not significantly different between SARS-CoV-2 positive KTR and non-KTR, but there was a notable trend towards higher mortality in SARS-CoV-2 positive KTR (25% vs. 16%, p=0.15, respectively). Conclusion. Hospitalized SARS-CoV-2 positive KTR had a high rate of mortality and hospital complications such as requiring ventilation, vasopressor use, and AKI. Additionally they had higher odds of hospital complications compared to SARS-CoV-2 positive non-KTR after adjusting for Elixhauser score, Black race and baseline eGFR. Future studies with larger sample size of KTR need to validate our findings.