Coronavirus disease 2019 in kidney transplant recipients: a systematic review and meta-analysis

Introduction: The clinical presentation and outcomes of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs) have not been well studied. Methods: We performed a meta-analysis to examine the presenting features, outcomes and the effect of treatment on outcomes of KTRs with COVID-19. Database search was performed up to 5 September 2020 through PubMed, EMBASE, Web of Science, SCOPUS, and CENTRAL. Results: Overall, 23 studies (1373 patients) were included in the review and meta-analysis. The most common presenting symptoms included fever (74.0%, 95% confidence interval [CI] 65.3–81.1), cough (63.3% 95% CI 56.5–69.6) and dyspnoea (47.5%, 95% CI 39.6–55.6). Pooled rates of mortality and critical illness were 21.1% (95% CI 15.3-28.4) and 27.7% (95% CI 21.5–34.8) respectively. Acute kidney injury occurred in 38.9% (95% CI 30.6–48.1) and dialysis was required in 12.4% (95% CI 8.3–18.0) of the cases. Discussion: KTRs with COVID-19 have a similar clinical presentation as the general population but have higher morbidity and mortality. It is uncertain whether high dose corticosteroid or hydroxychloroquine reduces the risks of mortality in KTRs with COVID-19.

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Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10215162 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5162

Author(s):

Jia-Jin Chen ◽

George Kuo ◽

Tao Han Lee ◽

Huang-Yu Yang ◽

Hsin Hsu Wu ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Transplant ◽

Meta Analysis ◽

Graft Loss ◽

Kidney Injury ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Kidney Replacement Therapy

The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.

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Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

World Journal of Transplantation ◽

10.5500/wjt.v7.i1.81 ◽

2017 ◽

Vol 7 (1) ◽

pp. 81 ◽

Cited By ~ 17

Author(s):

Wisit Cheungpasitporn ◽

Charat Thongprayoon ◽

Michael A Mao ◽

Shennen A Mao ◽

Matthew R D'Costa ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Kidney Transplant ◽

Meta Analysis ◽

Kidney Injury ◽

Transplant Recipients ◽

Kidney Transplant Recipients

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Immunosuppressive Management of Pediatric Kidney Transplant Recipients

Current Pharmaceutical Design ◽

10.2174/1381612826666200708133429 ◽

2020 ◽

Vol 26 (28) ◽

pp. 3451-3459

Author(s):

Tomáš Seeman

Keyword(s):

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Induction Therapy ◽

Graft Loss ◽

Calcineurin Inhibitors ◽

Mtor Inhibitors ◽

Therapeutic Drug ◽

High Dose ◽

Transplant Recipients ◽

Kidney Transplant Recipients

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

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Outcomes of bisphosphonate and its supplements for bone loss in kidney transplant recipients: a systematic review and network meta-analysis

BMC Nephrology ◽

10.1186/s12882-018-1076-1 ◽

2018 ◽

Vol 19 (1) ◽

Author(s):

Yan Yang ◽

Shi Qiu ◽

Linghui Deng ◽

Xi Tang ◽

Xinrui Li ◽

...

Keyword(s):

Systematic Review ◽

Bone Loss ◽

Kidney Transplant ◽

Meta Analysis ◽

Transplant Recipients ◽

Kidney Transplant Recipients

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2658. Meningitis in Kidney Transplant Recipients: TransMéninges, a French Multicentric Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2336 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S930-S930

Author(s):

Yanis Tamzali ◽

Anne Scemla ◽

Pierre Taupin ◽

Sunny Randhawa ◽

Valérie Moal ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Immunosuppressive Treatment ◽

Induction Treatment ◽

High Dose ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Specific Population ◽

Gram Negative ◽

Wide Range

Abstract Background The management of meningitis requires the prompt introduction of high-dose probabilistic anti-infectious therapy. The literature reporting on meningitis in kidney transplant recipients (KTR) is scarce and no recommendation exists for this specific population. Methods We retrospectively included all adult KTRs diagnosed with meningitis (cerebro-spinal fluid (CSF) cell count >10/mm3 or positive fungal antigen or direct examination) between 2007 and 2018 in 16 French hospitals. Clinical, biological, and therapeutic data, and 1-year kidney and patient survival were collected. Results Meningitis occurred in 134 KTRs (mean age 57+/11.8 years, 56% male), after a median time of 27 months (IQR 8–65); 25% of patients received an immunosuppressive treatment before kidney transplantation, induction treatment included lymphocyte-depleting antibodies in 63%, and 53% presented diabetes (34% before and 19% after the transplantation). The etiologies included Cryptococcus neoformans (30%), Herpesviridae (22%, including Varicella-Zoster Virus 15%), idiopathic forms (11%), Gram-negative bacilli (8% of which 20% produced an extended spectrum β-lactamase), %), infusion of intravenous immunoglobulins (6%), post-transplant lymphoproliferative disorders (5%), Aspergillus fumigatus (4%), Listeria monocytogenes (4%), Enterovirus (4%), and Mycobacterium tuberculosis (3%). The most common symptoms were fever (82.5%), headaches (75%), encephalitis (55%), and convulsion (22.5%). CSF hypercellularity (found in 92% of the cases) was lymphocytic in 65% of the cases and neutrophilic in 35%. Initial anti-infectious therapy was inappropriate in 27% of the cases. One-year patient, graft, and death-censored graft survival rates were 84%, 76%, and 89%, respectively. Conclusion Meningitis after kidney transplantation encompasses a wide range of causes, with C. neoformans and VZV explaining more than 50% of the cases. Gram-negative bacilli are the most represented bacteria with a high rate of antimicrobial resistance. Treatment guidelines should be reconsidered in the specific population of KTRs as the etiology greatly differs from what is observed in the general population. Disclosures All authors: No reported disclosures.

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Tuberculosis Characterization in a Special Population of Kidney Transplant Recipients

ISRN Infectious Diseases ◽

10.5402/2013/491942 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Barbara Reis-Santos ◽

Ethel Leonor Noia Maciel

Keyword(s):

Kidney Transplant ◽

Clinical Presentation ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Careful Evaluation ◽

Tb Control ◽

Health History ◽

Sociodemographic Data ◽

Clinical Records ◽

Active Disease

Setting. Tuberculosis clinical presentation is not typical in kidney transplant recipients and the diagnosis of active disease is usually delayed. Objective. To characterize tuberculosis presentation in Brazilian's kidney transplant recipients. Study Design. We analyzed the clinical records of tuberculosis cases regarding sociodemographic data and health history. Results. Thirteen TB cases were identified among 843 transplant recipients. The average time for TB development after transplantation was 4 years. Eight subjects presented pulmonary disease, seven patients required hospitalization Alertness to the possibility of TB and the careful evaluation for possible TB of all kidney transplant recipients with unexplained is vital, as is the related work of transplant and TB control teams and four died as a consequence of TB. Conclusion. The severe consequences of TB in posttransplantation can become critical.

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