Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients

Bastien Berger (1) , Marc Hazzan , Nassim Kamar , Hélène Francois , Marie Matignon (2) , Clarisse Greze , Philippe Gatault , Luc Frimat (3) , Pierre Westeel , Valentin Goutaudier , Renaud Snanoudj , Charlotte Colosio , Antoine Sicard , Valerie Moal , Dominique Bertrand , Christiane Mousson , Jamal Bamoulid , Paolo Malvezzi , Antoine Thierry , Dany Anglicheau (4) , Lionel Couzi (5) , Jonathan Chemouny (6, 7, 8) , Agnes Duveau , Yannick Le Meur (9) , Gilles Blancho , Jérôme Tourret , Christophe Mariat , Jean-Philippe Rerolle , Nicolas Bouvier , Sophie Caillard (10, 11) , Olivier Thaunat (1, 11)

1 HCL - Hospices Civils de Lyon
2 IMRB - Institut Mondor de Recherche Biomédicale
3 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
4 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
5 ImmunoConcept - Immunology from Concept and Experiments to Translation
6 CHU Pontchaillou [Rennes]
7 Irset - Institut de recherche en santé, environnement et travail
8 CIC - Centre d'Investigation Clinique [Rennes]
9 Inserm UMR 1227 Immunothérapies et Pathologies Lymphocytaires B
10 Immuno-Rhumatologie Moléculaire
11 CIRI - Centre International de Recherche en Infectiologie

Introduction - SARS-CoV-2 pandemic evolved in 2 consecutive waves during 2020. Improvements in the management of COVID-19 led to a reduction in mortality rates among hospitalized patients during the second wave. Whether this progress benefited kidney transplant recipients (KTRs), a population particularly vulnerable to severe COVID-19, remained unclear. Methods - In France, 957 KTRs were hospitalized for COVID-19 in 2020 and their data were prospectively collected into the French Solid Organ Transplant (SOT) COVID registry. The presentation, management, and outcomes of the 359 KTRs diagnosed during the first wave were compared to those of the 598 of the second wave. Results - Baseline comorbidities were similar between KTRs of the 2 waves. Maintenance immunosuppression was reduced in most patients but withdrawal of antimetabolite (73.7% vs. 58.4%,  < 0.001) or calcineurin inhibitor (32.1% vs. 16.6%,  < 0.001) was less frequent during the second wave. Hydroxychloroquine and azithromycin that were commonly used during the first wave (21.7% and 30.9%, respectively) but were almost abandoned during the second wave. In contrast, the use of high dose corticosteroids doubled (19.5% vs. 41.6%,  < 0.001). Despite these changing trends in COVID-19 management, 60-day mortality was not statistically different between the 2 waves (25.3% vs. 23.9%; Log Rank,  = 0.48) and COVID-19 hospitalization period was not associated with death due to COVID-19 in multivariate analysis (Hazard ratio 0.89, 95% confidence interval 0.67-1.17,  = 0.4). Conclusion - We conclude that changing of therapeutic trends during 2020 did not reduce COVID-19 related mortality among KTRs. Our data indirectly support the importance of vaccination and neutralizing monoclonal anti-SARS-CoV-2 antibodies to protect KTRS from severe COVID-19.

Keywords: SARS-CoV2; Transplantation

Domains: Life Sciences [q-bio]

Bastien Berger, Marc Hazzan, Nassim Kamar, Hélène Francois, Marie Matignon, et al.. Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients. Kidney International Reports, 2022, 7 (12), pp.2617-2629. ⟨10.1016/j.ekir.2022.09.007⟩. ⟨hal-03800251v2⟩