Korean J Transplant.  2022 Nov;36(Supple 1):S11. 10.4285/ATW2022.F-0863.

Outcomes of immunosuppression regimen modification strategies among kidney transplant recipients admitted for COVID-19 infection at the National Kidney and Transplant Institute

• Manzanilla PM
• Arakama MH

• KMID: 2535127
• DOI: http://doi.org/10.4285/ATW2022.F-0863

Abstract

Kidney transplant recipients (KTRs) are a vulnerable population in COVID-19 infections due to their necessary immunosuppres-sion. These are adjusted when a KTR contracts COVID-19 infection, but there remains no conclusive data as to how this is best done. The objective of this study was to assess the outcomes of KTRs who contracted COVID-19, with regards to whether or not their immunosuppression regimens were altered/adjusted. The outcomes of interest were: mortality, length of hospital stay, progression of COVID-19, acute kidney injury (AKI), renal replacement therapy (RRT), graft loss, biopsy proven rejection, and cardiac/cerebrovascular events. This was a retrospective analytical study which included 206 KTRs diagnosed with COVID-19 infection and admitted from January 2020 until December 2021 at the National Kidney and Transplant Institute. Cross-tabu-lation was done to describe the Immunosuppression modification strategies utilized. Chi-square test and risk ratio (with 95% confidence interval) were used to determine the association of strategies and the outcomes. Results showed that mortality rate (25.7%), length of stay (median 12 days), AKI incidence (37.9%) and RRT utilization (19.4%) were comparable to previous studies and institutions. Shifting oral steroids to dexamethasone decreased risk of covid progression (P=0.00) and discontinuing an-timetabolite drugs in COVID-19 severe patients decreased risk of RRT (P=0.043). Discontinuing calcineurin inhibitors led to a longer hospital stay for COVID-19 severe patients (P=0.02). Data did not support the other strategies. This study concluded that for COVID-19 severe patients, shifting oral steroids to dexamethasone and discontinuing antimetabolite drugs should be done; calcineurin inhibitors should be maintained. For all other strategies in all other use cases (COVID-19 mild, moderate and critical patients), there is insufficient evidence for or against adjusting medications.