Mortality among kidney transplant recipients with SARS-CoV-2: a systematic review and meta-analysis of cohorts and clinical registries

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Abstract

Background. The number of recipients living with a kidney transplant continues to grow. Parenchymal organ recipients receiving chronic immunosuppressive therapy are at increased risk of severe SARS-CoV-2 [1, 2]. This requires a dynamic assessment of mortality among kidney transplant recipients with SARS-CoV-2.

Objective. Comparative assesmrnt of the data on mortality and immunosuppressive therapy in kidney transplant recipients (KTR) with SARS-CoV-2 who lived for more than a year after kidney allotransplantation (KAT) and were treated in various clinical centers in Moscow from 02/01/2020 to 09/30/2020 according to the UMIAS data, with a systematic analysis of published studies on the same topic for a similar period of time.

Material and methods. The electronic MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials databases were searched for eligible studies. All prospective and retrospective mortality studies with ≥ 50 KTR patients with SARS-CoV-2 were considered eligible. A meta-analysis of proportions was performed using the Freeman-Tukey transform to calculate the weighted summary proportion under the fixed and random effects model. Of the total number of 379 studies found, 13 were included in the systematic review and meta-analysis, incl. and ours, with a total of 3333 KTRs with SARS-CoV-2.

Results. In the survival analysis, the proportion of deaths averaged 19.82% (fixed model) and 19.30% (random model). The mortality rate of KTRs with SARS-CoV-2 recorded in UMIAS turned out to be almost the same (19.55%). A positive effect of tacrolimus therapy on survival of KTRs with SARS-CoV-2 has been identified. Tacrolimus was used more frequently in survivors (Me 0.7890, 95% CI 0.5828–0.9200, IQR 0.5828–0.9200) compared to non-survivors (Me 0.7860, 95% CI 0.3800–0, 8625, IQR 0.3800–0.8295), P=0.0195. Therapy with glucocorticosteroids was more often carried out among the deceased, however, the data obtained in the meta-analysis were not reliable (P = 0.25). Meta-analysis data were characterized by low heterogeneity (I2 -75.42%; P<0.0001). Errors in the selection of publications according to the Egger and Begg test were not identified.

Conclusion. This meta-analysis suggests that mortality among KTRs with SARS-CoV-2 hospitalized and treated in various clinical centers in Moscow, according to UMIAS from 02/01/2020 to 09/30/2020, did not differ from the population among the same patients for the same period time. A positive effect of tacrolimus therapy on the survival of KTRs with SARS-CoV-2 was revealed.

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About the authors

Maria S. Novikova

Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Endocrinological Dispensary of the Moscow Healthcare Department

Author for correspondence.
Email: citrus7474@mail.ru

Cand. Sci. (Med.), Associate Professor at the Department of Therapy, Cardiology and Functional Diagnostics with a Course of Nephrology, Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Nephrologist at the Endocrinological Dispensary of the Moscow Healthcare Deparment

Russian Federation, Moscow; Moscow

Larisa O. Minushkina

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Email: minushkina@mail.ru

Dr.Sci. (Med.), Professor at the Department of Therapy, Cardiology and Functional Diagnostics with a Course of Nephrology

Russian Federation, Moscow

Oleg N. Kotenko

Moscow City Scientific and Practical Center for Nephrology and Transplanted Kidney Pathology, City Clinical Hospital № 52; Pirogov Russian National Research Medical University

Email: olkotenko@yandex.ru

Cand. Sci. (Med.), Chief Specialist in Nephrology of the Moscow Healthcare Department, Head of the Moscow City Scientific and Practical Center for Nephrology and Transplanted Kidney Pathology, City Clinical Hospital № 52 of the Moscow Healthcare Department

Russian Federation, Moscow; Moscow

Dmitry A. Zateyshchikov

Central State Medical Academy of the Administrative Department of the President of the Russian Federation; City Clinical Hospital № 29 n.a. N.E. Bauman of the Moscow Healthcare Department

Email: dz@bk.ru

Dr. Sci. (Med.), Professor, Head of the Department of Therapy, Cardiology and Functional Diagnostics with a Course of Nephrology, Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Head of the Primary Vascular Department, City Clinical Hospital № 29 n.a. N.E. Bauman of the Moscow Healthcare Department

Russian Federation, Moscow; Moscow

Olga I. Boeva

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Email: citrus7474@mail.ru

Dr Sci. (Med.), Professor at the Department of Therapy, Cardiology and Functional Diagnostics with a Course of Nephrology

Russian Federation, Moscow

Sona S. Allazova

Sechenov University

Email: tallisasoto@rambler.ru

PhD student at the Department of Internal, Occupational Diseases and Rheumatology, Institute of Clinical Medicine n.a. N.V. Sklifosovsky

Russian Federation, Moscow

Evgeny M. Shilov

Sechenov University

Email: emshilov@mma.ru

Dr. Sci. (Med.), Professor at the Department of Internal, Occupational Diseases and Rheumatology, Institute of Clinical Medicine n.a. N.V. Sklifosovsky

Russian Federation, Moscow

Olga M. Koteshkova

Endocrinological Dispensary of the Moscow Healthcare Department

Email: ed@zdrav.mos.ru

Cand. Sci. (Med.), Head of the Department of Education and Treatment of Diabetes Mellitus

Russian Federation, Moscow

Mikhail B. Antsiferov

Endocrinological Dispensary of the Moscow Healthcare Department

Email: ed@zdrav.mos.ru

Dr.Sci. (Med.), Professor, Chief Specialist in Endocrinology of the Moscow Healthcare Department, President of the Endocrinological Dispensary of the Moscow Healthcare Department

Russian Federation, Moscow

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