Clinical Characteristics and Outcomes of Unvaccinated Kidney Transplant Recipients Infected with the SARS-CoV-2 Omicron Variant: A Case Series

Author:

Qu Yue1,Zhuang Jing1,Duan Yanya1,Baibutihan Ahebaota1,Maimaiti Zuolamu1,Zhang Changrong1,Niu Junqiao2,Teng Wei3,Ailimu Maierdang4,Wei Xuemei5,Qi Baowen6,Li Jiuzhi7,Du Shuang1,Wang Dingding1,Cao Ke1,Wang Junyan1,Lu Chen8,Tian Xuefei9ORCID,Jiang Hong1ORCID

Affiliation:

1. Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

2. Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

3. Department of Pharmacy, Institute of Clinical Pharmacy of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

4. Organ Transplantation Office of the Medical Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

5. Respiratory and Critical Care Medical Center, People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

6. Department of Ultrasound Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

7. Department of Urology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China.

8. Division of Nephrology, Department of Internal Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.

9. Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06519, United States.

Abstract

ABSTRACT Background: Due to their chronic immunocompromised status, kidney transplant (KT) recipients face escalated risks from coronavirus disease 2019 (COVID-19), which may be exacerbated by lower vaccination rates. However, there is a paucity of information regarding the clinical traits of unvaccinated KT recipients with COVID-19. We aimed to investigate the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection in unvaccinated KT recipients. Methods: In this retrospective study, we analyzed the clinical outcomes of 36 unvaccinated KT recipients diagnosed with SARS-CoV-2 Omicron infection, as confirmed by reverse transcription polymerase chain reaction. Clinical characteristics, laboratory tests, treatment regimens, and outcomes were examined, and 2-month follow-up assessments were conducted. Results: KT recipients had a high incidence of severe infection, with 66.7% classified as having severe/critical illness. Factors associated with severe/critical illness included age; diabetes mellitus; lung infection computed tomography score; and elevated serum D-dimer, interleukin-6, C-reactive protein, procalcitonin, and ferritin levels. The patients in the severe/critical group also had significantly lower blood lymphocyte counts and serum albumin levels. Treatment strategies included discontinuation of antimetabolic drugs, reduction or discontinuation of calcineurin inhibitor drugs, antiviral therapy, and early patient-tailored nutritional support. Acute kidney injury was observed in 19.4% of patients. Four (11.1%) patients died during the observation period, with two (5.6%) succumbing hospitalization and two (5.6%) during the 2-month follow-up period due to infection. The remaining patients did not report any significant symptoms and are still undergoing follow-up. Conclusion: Early diagnosis, personalized treatment, and vigilant monitoring are all crucial aspects of the clinical management of unvaccinated KT recipients with COVID-19. These findings contribute to the understanding of the clinical characteristics and management of COVID-19 in patients undergoing KT.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference40 articles.

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