Data show 25% mortality rate among European transplant patients with COVID-19
Data collected by the European Renal Association-European Dialysis and Transplant Association since March show 25% of kidney transplant patients diagnosed with COVID-19 in European countries have died.
The international data have been collected by ERACODA, the largest international COVID-19 database of kidney transplant and dialysis patients, the ERA-EDTA said in a press release.
“There are several reasons why kidney transplant patients could be at higher risk,” Luuk Hilbrands, MD, PhD, with the department of nephrology at Radboud University Medical Center in the Netherlands, said during a press conference. “Not only do they often have known risk factors for severe COVID-19, but they also take daily immunosuppressive drugs that impair their immune response.”
However, those drugs may actually be protective for transplant patients, he said. “Immunosuppressive drugs may also reduce the hyperinflammatory response in severe COVID-19, and some immunosuppressants (for example, cyclosporine) inhibit coronavirus replication in the laboratory.” Transplant patients are also sensitive to the risks of infection, Hilbrands said. “They are aware of their vulnerable condition; they are used to protecting themselves against infection.”
ERACODA contains data on patients who underwent kidney transplant, as well as those on dialysis. As of June 1, the registry had 1,073 patients with COVID-19 and complete 28-day follow-up on these patients submitted by 197 physicians from 98 centers in 26 countries, mainly in Europe, the ERA-EDTA said. Of patients included in the database, 305 (28%) were kidney transplant recipients.
In the first 28 days, 21% of the patients had died — a case fatality rate only slightly lower than the 25% case fatality rate seen in patients on dialysis, according to data presented by Hilbrands.
In patients managed outside the hospital, mortality was 3% for kidney transplant patients compared to 5% for patients on dialysis. Following hospital admission, 24% of transplant patients died compared to 33% of patients on dialysis. Of those treated in the ICU, 45% of kidney transplant patients died compared with 53% of patients on dialysis.
The ERACODA data also allowed investigators to evaluate the prognostic indicators that were the leading causes of death among transplant patients. As in the general population, transplant patients with an age of 75 years and older “by far was the most important risk factor for poor outcomes,” Hilbrands said. However, other risk factors that Hilbrands said were often link to mortality among transplant patients – male sex, diabetes and cardiovascular disease – were not associated with a higher mortality risk for transplant patients with COVID-19, Hilbrands said.
“We were not able to observe that certain immunosuppressive drugs or changes in the therapy had an impact on the outcomes,” he said. There was also no evidence of benefit from treatment with antiviral drugs, or reduction or withdrawal of immunosuppressive therapy.
“With longer-term follow-up, we will be able to evaluate the consequences of COVID-19 for long-term kidney graft function,” Hilbrands said.
The ERACODA database was established in March 2020. Participating physicians submit data voluntarily on all consecutive adult kidney transplant and dialysis patients treated at their centers for COVID-19, either as outpatients or in the hospital, the ERA-EDTA said.