Mortality among kidney transplant recipients with SARS-CoV-2: a systematic review and meta-analysis of cohorts and clinical registries
- Autores: Novikova M.S.1,2, Minushkina L.O.1, Kotenko O.N.3,4, Zateyshchikov D.A.1,5, Boeva O.I.1, Allazova S.S.6, Shilov E.M.6, Koteshkova O.M.2, Antsiferov M.B.2
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Afiliações:
- Central State Medical Academy of the Administrative Department of the President of the Russian Federation
- Endocrinological Dispensary of the Moscow Healthcare Department
- Moscow City Scientific and Practical Center for Nephrology and Transplanted Kidney Pathology, City Clinical Hospital № 52
- Pirogov Russian National Research Medical University
- City Clinical Hospital № 29 n.a. N.E. Bauman of the Moscow Healthcare Department
- Sechenov University
- Edição: Volume 15, Nº 1 (2023)
- Páginas: 13-20
- Seção: Original Articles
- URL: https://journals.eco-vector.com/2075-3594/article/view/430405
- DOI: https://doi.org/10.18565/nephrology.2023.1.13-20
- ID: 430405
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Resumo
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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Sobre autores
Maria Novikova
Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Endocrinological Dispensary of the Moscow Healthcare Department
Autor responsável pela correspondência
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
Rússia, Moscow; MoscowLarisa 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
Rússia, MoscowOleg 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
Rússia, Moscow; MoscowDmitry 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
Rússia, Moscow; MoscowOlga 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
Rússia, MoscowSona 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
Rússia, MoscowEvgeny 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
Rússia, MoscowOlga 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
Rússia, MoscowMikhail 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
Rússia, MoscowBibliografia
- Mahalingasivam V., Craik A., Tomlinson L.A., et al. A Systematic Review of COVID-19 and Kidney Transplantation. Kidney Int. Rep. 2021;6(1):24–45. Doi: https://doi.org/10.1016/j.ekir.2020.10.023.
- Moosavi S.A., Mashhadiagha A., Motazedian N., et al. COVID-19 clinical manifestations and treatment strategies among solid-organ recipients: A systematic review of cases. Transplantat Inf. Dis. 2020;22(6):13427. https://doi.org/10.1111/tid.13427
- Abu Jawdeh B.G. COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges. ACKD. 2020;27(5):383–89. Doi: https://doi.org/10.1053/j.ackd.2020.07.004
- Maggiore U., Abramowicz D., Crespo M., et al. How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion. Nephrol. Dial. Transplant. 2020;35(6):899–904. https://doi.org/10.1093/ndt/gfaa130
- Tang X., Feng Y., Ni J., et al. Early Use of Corticosteroid May Prolong SARS-CoV-2 Shedding in Non-Intensive Care Unit Patients with COVID-19 Pneumonia: A Multicenter, Single-Blind, Randomized Control Trial. Respirat. 2021;100(2):116–26. https://doi.org/10.1159/000512063
- Pinzón M.A., Ortiz S., Holguín H., et al. Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia. PLoS One. 2021;16(5):0252057. https://doi.org/10.1371/journal. .pone.0252057
- Willicombe M.G., Sarah M.B., et al. Identification of Patient Characteristics Associated With SARS-CoV-2 Infection and Outcome in Kidney Transplant Patients Using Serological Screening. Transplant. 2021;105(1):151–57. doi: 10.1097/TP.0000000000003526.
- Bossini N., Alberici F., Delbarba E., et al. Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience. Am. J. Transplant. 2020;20:3019–29. doi: 10.1111/ajt.16176.
- Kute V.B., Anil K., Guleria, et al. Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India. Transplant. 2021;105(4):851–60. doi: 10.1097/TP.0000000000003593.
- Requião-Moura L.R., de Sandes-Freitas T.V., Viana L.A., et al. High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: Results from the Brazilian multicenter cohort study. PLoS One. 2021;16(7):0254822. https://doi.org/10.1371/journal.pone.0254822
- Liberati A., Altman D.G., Tetzlaff J., et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. Plos Med. 2009. https://doi.org/10.1371/journal.pmed.1000100
- Lin L. Bias caused by sampling error in meta-analysis with small sample sizes. PloS One. 2018. https://doi.org/10.1371/journal.pone.0204056.
- von Elm E., Altman D.G., Egger M., et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. JCE. 2008;61(4):309–414. Doi: https://doi.org/10.1016/j.jclinepi.2007.11.008.
- Pereira T.V., Patsopoulos N.A., Salanti G., et al. Critical interpretation of Cochran's Q test depends on power and prior assumptions about heterogeneity. Res. Synthes. Methods. 2010;1(2):149–61. https://doi.org/10.1002/jrsm.13
- Higgins J.P.T. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557. Doi: https://doi.org/10.1136/bmj.327.7414.557.
- Nik Ruzni Nik Idris. A Comparison of Methods to Detect Publication Bias for Meta-analysis of Continuous Data. J. Appl. Sci. 2012;12(13):1413–17. doi: 10.3923/jas.2012.1413.1417.
- Cravedi P., Mothi S.S., Azzi Y., et al. COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium. Am. J. Transplant. 2020;20(11):3140–48. https://doi.org/10.1111/ajt.16185
- Caillard S., Anglicheau D., Matignon M., et al. An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Clin. Investigat. 2020;98(6):1549–58. Doi: https://doi.org/10.1016/j.kint.2020.08.005.
- Azzi Y., Parides M., Alani O., et al. COVID-19 infection in kidney transplant recipients at the epicenter of pandemics. Clin. Investigat. 2020;98(6):1559–67. Doi: https://doi.org/10.1016/j.kint.2020.10.004.
- Craig-Schapiro R., Salinas Th., Lubetzky M., et al. COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients. Am. J. Transplant. 2021;21(4):1576–85. https://doi.org/10.1111/ajt.16351
- Hilbrands L.B., Duivenvoorden R., Vart P., et al. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrol. Dial. Transplant. 2020;35(11):1973–83. https://doi.org/10.1093/ndt/gfaa261
- Mamode N., Ahmed Z., Jones G., et al. Mortality Rates in Transplant Recipients and Transplantation Candidates in a High-prevalence COVID-19 Environment. Transplantat. 2021;105(1):212–15. doi: 10.1097/TP.0000000000003533.
- Oto O.A., Ozturk S., Turgutalp K., et al. Predicting the outcome of COVID-19 infection in kidney transplant recipients. BMC. Nephrol. 2021;22:100. https://doi.org/10.1186/s12882-021-02299-w
- Villanego F., Mazuecos A., Pérez-Flores I.M., et al. Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry. Am. J. Transplant. 2021;21(7):2573–82. https://doi.org/10.1111/ajt.16579
- Alshaqaq A., Abadi A.A., Altheaby A., et al. Coronavirus Disease 2019 and Kidney Transplantation in Saudi Arabia: Outcomes and Future Opportunities. Ann. Transplant. 2021;26:931832. doi: 10.12659/AOT.931832.
- Фомина Д.С., Потешкина Н.Г., Белоглазова И.П. и др. Сравнительный анализ применения тоцилизумаба при тяжелых COVID-19-ассоциированных пневмониях у пациентов разных возрастных групп. Пульмонология. 2020;30(2):164–72. https://doi.org/10.18093/0869-0189-2020-30-2-164-172. [Fomina D.S., Poteshkina N.G., Beloglazova I.P., etc. Comparative analysis of the use of tocilizumab in severe COVID-19-associated pneumonia in patients of different age groups. Pulmonology. 2020;30(2):164–72 (In Russ.)].
- Зелтынь-Абрамов Е.М., Лысенко М.А., Фролова Н.Ф. и др. Факторы риска неблагоприятного прогноза COVID-19 и опыт применения тоцилизумаба у пациентов на программном гемодиализе в исходе диабетической болезни почек. Сахарный диабет. 2021;24(1):17–31. https://doi.org/10.14341/DM12688. [Zeltyn-Abramov E.M., Lysenko M.A., Frolova N.F., etc. Risk factors for an unfavorable prognosis of COVID-19 and the experience of using tocilizumab in patients on programmed hemodialysis in the outcome of diabetic kidney disease. Diabetes mellitus. 2021;24(1):17–31. (In Russ.)]. https://doi.org/10.14341/DM12688
- Ким И.Г., Артюхина Л.Ю., Фролова Н.Ф. и др. SARS-CoV-2 инфекция у реципиентов почечного трансплантата. Нефрология и диализ. 2021;23(2):174–84. doi: 10.28996/2618-9801-2021-2-174-184. [Kim I.G., Artyukhina L.Yu., Frolova N.F. et al. SARS-CoV-2 infection in kidney transplant recipients. Nephrology and dialysis. 2021;23(2):174–84. doi: 10.28996/2618-9801-2021-2-174-184. (In Russ.)].
- Carbajo-Lozoyaa J., Müllerb M.A., Kallies S., et al. Replication of human coronaviruses SARS-CoV, HCoV-NL63 and HCoV-229E is inhibited by the drug FK506. Virus Res. 2012;165 (1):112–17.
- Alberici F., Delbarba E., Manenti Ch., et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int. 2020;97(6):1083–88. doi: 10.1016/j.kint.2020.04.002.
- Russell B., Moss Ch., George G., et al. Associations between immune-suppressive and stimulating drugs and novel COVID-19 – a systematic review of current evidence. Cancer. 2020;14:1022. Doi: https://doi.org/10.3332/ecancer.2020.1022.
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