Abstract：
COVID-19 infection is considered to cause high mortality in kidney transplant recipients (KTR). Old age, comorbidities and acute kidney injury are known risk factors for increased mortality in KTR. Nevertheless, mortality rates have varied across different regions. Differences in age, comorbidities and varying standards of care across geographies may explain some variations. However, it is still unclear whether post-transplant duration, induction therapy, antirejection therapy and co-infections contribute to increased mortality in KTR with COVID-19. The present study assessed risk factors in a large cohort from India.
A matched case-control study was performed to analyze risk factors for death in KTR (N = 218) diagnosed with COVID-19 between April 2020 to July 2021 at the study centre. Cases were KTR who died (non-survivors, N = 30), whereas those who survived were taken as controls (survivors, N = 188).
A high death-to-case ratio of 13.8% was observed amongst study group KTR infected with COVID-19. There was a high incidence (12.4%) of co-infections, with cytomegalovirus being the most common co-infection among non-survivors. Diarrhea, co-infection, high oxygen requirement, and need for mechanical ventilation were significantly associated with mortality on regression analyses. Antirejection therapy, lymphopenia and requirement for renal replacement therapy were associated with worse outcomes.
The mortality was much higher in KTR who required mechanical ventilation and had co-infections. Mortality did not vary with the type of transplant, post-transplant duration and usage of depletion induction therapy. An aggressive approach has to be taken for an early diagnosis and therapeutic intervention of associated infections.
A matched case-control study was performed to analyze risk factors for death in KTR (N = 218) diagnosed with COVID-19 between April 2020 to July 2021 at the study centre. Cases were KTR who died (non-survivors, N = 30), whereas those who survived were taken as controls (survivors, N = 188).
A high death-to-case ratio of 13.8% was observed amongst study group KTR infected with COVID-19. There was a high incidence (12.4%) of co-infections, with cytomegalovirus being the most common co-infection among non-survivors. Diarrhea, co-infection, high oxygen requirement, and need for mechanical ventilation were significantly associated with mortality on regression analyses. Antirejection therapy, lymphopenia and requirement for renal replacement therapy were associated with worse outcomes.
The mortality was much higher in KTR who required mechanical ventilation and had co-infections. Mortality did not vary with the type of transplant, post-transplant duration and usage of depletion induction therapy. An aggressive approach has to be taken for an early diagnosis and therapeutic intervention of associated infections.
摘要：
COVID-19感染被认为会导致肾移植受者（KTR）的高死亡率。老年,合并症和急性肾损伤是KTR死亡率增加的已知危险因素。然而，不同地区的死亡率各不相同.年龄差异,不同地区的合并症和不同的护理标准可能解释了一些差异。然而,目前还不清楚移植后的持续时间，诱导治疗,抗排斥治疗和共感染导致COVID-19患者的死亡率增加。本研究评估了来自印度的大型队列中的风险因素。
在研究中心进行了一项匹配的病例对照研究，以分析2020年4月至2021年7月期间诊断为COVID-19的KTR（N=218）的死亡危险因素。病例是死亡的KTR(非幸存者，N=30),而那些幸存下来的人被视为对照(幸存者，N=188）。
在感染COVID-19的KTR研究组中观察到13.8%的高死亡率。合并感染的发生率很高（12.4％），巨细胞病毒是非幸存者中最常见的共感染。腹泻,合并感染,需氧量高,在回归分析中,机械通气的需要与死亡率显著相关.抗排斥治疗,淋巴细胞减少和需要肾脏替代治疗与更差的预后相关.
需要机械通气和合并感染的KTR的死亡率要高得多。死亡率并不随移植类型而变化,移植后的持续时间和耗竭诱导治疗的使用。必须采取积极的方法对相关感染进行早期诊断和治疗干预。
在研究中心进行了一项匹配的病例对照研究，以分析2020年4月至2021年7月期间诊断为COVID-19的KTR（N=218）的死亡危险因素。病例是死亡的KTR(非幸存者，N=30),而那些幸存下来的人被视为对照(幸存者，N=188）。
在感染COVID-19的KTR研究组中观察到13.8%的高死亡率。合并感染的发生率很高（12.4％），巨细胞病毒是非幸存者中最常见的共感染。腹泻,合并感染,需氧量高,在回归分析中,机械通气的需要与死亡率显著相关.抗排斥治疗,淋巴细胞减少和需要肾脏替代治疗与更差的预后相关.
需要机械通气和合并感染的KTR的死亡率要高得多。死亡率并不随移植类型而变化,移植后的持续时间和耗竭诱导治疗的使用。必须采取积极的方法对相关感染进行早期诊断和治疗干预。
