Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study
Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poo...
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JCDR Research and Publications Private Limited
2022-05-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/16340/52091_CE[Ra1]_F(KR)_PF1(RD_SHU_SS)_PFA(RD_KM)_PN(KM).pdf |
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| author | Shiva Kumar Ammayappan Arul Rajagopalan Jegan Arunachalam Arun Prasath Rakesh Durai Manorajan Rajendran Benoy Varghese Shanmuganathan Velu |
| author_facet | Shiva Kumar Ammayappan Arul Rajagopalan Jegan Arunachalam Arun Prasath Rakesh Durai Manorajan Rajendran Benoy Varghese Shanmuganathan Velu |
| author_sort | Shiva Kumar Ammayappan |
| collection | DOAJ |
| description | Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in post renal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients.
Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19.
Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis.
Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p<0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3%
Conclusion: Post kidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome. |
| first_indexed | 2024-04-10T15:50:15Z |
| format | Article |
| id | doaj.art-067e5acb5c2f4b18acd5162a1a5d8183 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-04-10T15:50:15Z |
| publishDate | 2022-05-01 |
| publisher | JCDR Research and Publications Private Limited |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-067e5acb5c2f4b18acd5162a1a5d81832023-02-11T10:21:38ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2022-05-01165OC17OC2310.7860/JCDR/2022/52091.16340Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational StudyShiva Kumar Ammayappan0Arul Rajagopalan1Jegan Arunachalam2Arun Prasath3Rakesh Durai4Manorajan Rajendran5Benoy Varghese6Shanmuganathan Velu7Resident, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Associate Professor, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Assistant Professor, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Assistant Professor, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Assistant Professor, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Professor, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Resident, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Resident, Department of Nephrology, Madurai Medical College, Madurai, Tamil Nadu, India.Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in post renal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients. Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19. Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis. Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p<0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3% Conclusion: Post kidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome.https://www.jcdr.net/articles/PDF/16340/52091_CE[Ra1]_F(KR)_PF1(RD_SHU_SS)_PFA(RD_KM)_PN(KM).pdfacute graft dysfunctionbiopsycoronavirus disease 2019dialysisimmunosuppressivesrejection |
| spellingShingle | Shiva Kumar Ammayappan Arul Rajagopalan Jegan Arunachalam Arun Prasath Rakesh Durai Manorajan Rajendran Benoy Varghese Shanmuganathan Velu Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study Journal of Clinical and Diagnostic Research acute graft dysfunction biopsy coronavirus disease 2019 dialysis immunosuppressives rejection |
| title | Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study |
| title_full | Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study |
| title_fullStr | Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study |
| title_full_unstemmed | Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study |
| title_short | Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study |
| title_sort | clinical course and outcome of covid 19 in kidney transplant recipients a single centre retrospective observational study |
| topic | acute graft dysfunction biopsy coronavirus disease 2019 dialysis immunosuppressives rejection |
| url | https://www.jcdr.net/articles/PDF/16340/52091_CE[Ra1]_F(KR)_PF1(RD_SHU_SS)_PFA(RD_KM)_PN(KM).pdf |
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