key: cord-0928131-3xn76809
authors: Redondo, Magdalena Terán; Martínez, Claudia Muñoz; Guerrero, Pedro Rosa; Morales, M. Luisa Agüera; De Rueda, Álvaro Torres; Benot, Alberto Rodríguez
title: HOSPITAL MANAGEMENT AND AMBULATORY PATIENT CARE AFTER COVID-19 INFECTION IN KIDNEY TRANSPLANT
date: 2021-11-12
journal: Transplant Proc
DOI: 10.1016/j.transproceed.2021.09.067
sha: 15331b9abf04624fe73be82db09a95ef0456f47b
doc_id: 928131
cord_uid: 3xn76809

INTRODUCTION A large number de registries have been collected both kidney transplant recipients infected with COVID-19. MATERIALS AND METHODS From March 2020 to April 2021, our team conducted an observational study, which included all patients that show a positive polymerase chain reaction to COVID-19. Patients were divided into two groups: ambulatory patient care and patient who need hospital admissions. RESULTS A total de 76 kidney transplants infected with COVID-19, 33% required hospital admission and 65% received ambulatory treatment. 28% of our patients were asymptomatic and 6,8% died. Immunosuppressive treatment was modified in both study groups, there were not any acute rejection episodes or changes in the HLA antibodies profile in our patients during our clinical trial. DISCUSSION In our study there was a significant percentage of patients who did not require hospital admission compared to other studies. In addition, we think that the reduction of immunosuppression can be a safe and reliable treatment.

immunosuppressive treatment.

Tables: Table 1 . Clinical and demographic characteristics according to the different study groups our team conducted an observational study, which included all patients that show a positive polymerase chain reaction to COVID-19. Patients were divided into two groups: ambulatory patient care and patient who need hospital admissions. RESULTS: A total de 76 kidney transplants infected with COVID-19, 33% required hospital admission and 65% received ambulatory treatment. 28% of our patients were asymptomatic and 6,8% died. Immunosuppressive treatment was modified in both study groups, there were not any acute rejection episodes or changes in the HLA antibodies profile in our patients during our clinical trial. DISCUSSION: In our study there was a significant percentage of patients who did not require hospital admission compared to other studies. In addition, we think that the reduction of immunosuppression can be a safe and reliable treatment. Hospital, which included all patients that showed a positive polymerase chain reaction (PCR) to COVID-19. We had a very reliable source of information at our disposal since we were informed by the Andalousian Autonomic Transplant Coordination Service with complete identifiable data from each patient with a functional kidney allograft who had eventually tested positive in a COVID-19 PCR test in primary or hospital care within the region. Patients were divided into two groups: ambulatory patient care and patients needing hospital admission.

RESULTS: A total of 76 kidney transplant recipients infected with COVID-19 were included in our study, which means 8.6% of the kidney transplant recipients being followed up at Reina Sofía University Hospital. From those, 25 patients required hospital admission and 49 patients received ambulatory treatment. There were 2 patients from whom we could not gather data. We compared the clinical and demographic characteristics from both groups ( Table 1) . 28% of our patients were asymptomatic and 6.8% died. As a consequence of the COVID-19 infection, 21.1% of our patients had a kidney graft dysfunction, 3 patients required renal replacement therapy and 1 patient required permanent hemodialysis. All modifications made in the immunosuppressive therapy are shown on Figure 1 . There were not acute rejection episodes or changes in the anti-HLA antibodies profile in our patients within the studied period. DISCUSSION: Compared with similar studies reporting a 21-28% of mortality (3,5,7), our series show a lower mortality rate (6,8%), a low incidence of hospital admissions (33%) and a high rate of asymptomatic patients (28%). It should be noted that most of our transplant patients with COVID infection were treated at home (65,3%). Other authors, as Cristelli et al reported that the majority of their patients required hospitalization (69%) and only 31% of their patients were treated at home (7) . We think that these results are attributable not only to the reliability of our sources of information in order to identify COVID positive patients with mild disease, but also to the fact that this kind of patients might had not been considered in other studies as accurately as we did. Our main conclusion was that the majority of our transplant patients with COVID infection were treated at home instead of being hospitalized unlike other series report. There is still some uncertainty about the optimal management of these patients after the development of COVID-19 infection. Moreover, the results show that infected kidney transplant recipients have a high mortality rate, as well as a high hospital admission rate (3)(5) compared to non-transplant controls. This might be justified by the immunosuppressive therapy, as well as by the comorbidities associated to this kind of patients. Health recommendations suggest the reduction of immunosuppression and even the removal of antimetabolite, mTOR inhibitors and calcineurin inhibitors (4)(5)(6) according to the clinical situation, which our records confirms takes place with our patients. Regarding corticosteroid treatment, the dose remained unchanged and, in some cases, was increased (6).

In conclusion, COVID-19 infection affects kidney transplant recipients more severely than it does with the general population, but nevertheless there is a significant percentage of pauci-symptomatic patients that could be managed at home. In addition, we think that a monitored reduction in immunosuppression is safe and may help successful recovery.

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