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

SARS-CoV-2 pandemic evolved in two consecutive waves over 2020. Improvements in the management of COVID-19 led to a reduction of mortality rates in hospitalized patients during the second wave. Whether this progress also benefited to kidney transplant recipients (KTR), a population particularly vulnerable to severe COVID-19, remained unclear. In France, 957 KTR were hospitalized for COVID-19 in 2020 and their data were prospectively collected in the French SOT COVID registry. The presentation, management, and outcomes of the 359 KTR diagnosed during the 1st wave were compared to those of the 598 of the 2nd wave. Baseline comorbidities were similar between KTR of the 2 waves. Maintenance immunosuppression was reduced in most patients but withdrawal of antimetabolite (73.7% vs 58.4%, p<0.001) or CNI (32.1% vs 16.6%, p<0.001) was less frequent during the 2nd wave. Hydroxychloroquine and azithromycin that were commonly used during the 1st wave (21.7% and 30.9%, respectively) were almost abandoned during the 2nd. In contrast, the use of high dose corticosteroids doubled (19.5% vs. 41.6%, p<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, p=0.48) and COVID-19 hospitalization period was not associated with death due to COVID in multivariate analysis (HR 0.89, 95% CI 0.67 - 1.17, p = 0.4). We conclude that changing of therapeutic trends during 2020 did not reduce COVID-19 related mortality in KTR. Our data indirectly support the importance of vaccination and monoclonal neutralizing anti-SARS-CoV-2 antibodies to protect KTR 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, ⟨10.1016/j.ekir.2022.09.007⟩. ⟨hal-03800251v1⟩