COVID-19 in elderly kidney transplant recipients

Crespo Barrio, Marta; Pérez-Sáez, María José; Redondo Pachón, María Dolores; Llinàs-Mallol, Laura; Montero, Maria Milagro; Villar García, Judit; Arias Cabrales, Carlos Enrique; Burballa Tàrrega, Carla, 1988-; Vázquez, Susana; Mir, Marisa; Sierra Ochoa, Adriana; Collado, Silvia; Barrios Barrera, Clara; Rodríguez García, Eva; Sans Atxer, Laia; Barbosa Puig, Francisco; Cao Baduell, Higinio; Arenas, María Dolores (Arenas Jiménez); Güerri Fernández, Roberto; Horcajada Gallego, Juan Pablo; Pascual Santos, Julio

doi:http://dx.doi.org/10.1111/ajt.16096

COVID-19 in elderly kidney transplant recipients

Citation

Crespo M, Pérez-Sáez MJ, Redondo-Pachón D, Llinàs-Mallol L, Montero MM, Villar-García J. et al. COVID-19 in elderly kidney transplant recipients. Am J Transplant. 2020 Oct; 20(10): 2883-89. DOI: 10.1111/ajt.16096

Abstract

The SARS-Cov-2 infection disease (COVID-19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March 12 until April 4, 2020, we diagnosed COVID-19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti-retroviral and tocilizumab. Short-term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail, and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic, and showed higher D-dimer, C-reactive protein, and IL-6 at their first tests. COVID-19 is frequent among the elderly KT population and associates a very early and high mortality rate.