Among kidney transplant recipients (KTRs) infected with SARS CoV-2, those who have elevations in biomarkers of inflammation, cardiac injury, and coagulation appear more likely to die.
In a French nationwide registry of 494 KTRs with COVID-19 during the first wave of the pandemic, 101 (20%) died. Patients with levels of serum creatinine above150 μmol/L, C-reactive protein above 50 mg/L procalcitonin above 0.3 mg/L, hs-troponin I above20 ng/L, lactate dehydrogenase above 280 UI/L, and D-dimer above 1500 UI/L were at increased risk for COVID-19-related mortality.
On multivariate analysis, only procalcitonin and troponin I remained independently associated with a significant 3.7- and 2.9-fold increased risk for mortality, respectively, Sophie Caillard, MD, PhD, of the Strasbourg University Hospital in Strasbourg Cedex, France, and colleagues reported in Kidney International Reports. Subgroup analyses additionally identified D-dimer as a prognostic biomarker.
The 60-day survival rate was as high as 92% among patients without elevation in any of the 3 biomarkers, but the rate declined to 77% among those with elevation of at least 1 of the biomarkers. The 60-day survival rate declined to 58% and 40% among patients with elevations in 2 and 3 biomarkers, respectively.
Several studies in the adult general population have found an association between elevation of cardiac injury, coagulation, and inflammatory biomarkers and COVID-19-related mortality, the investigators noted.
“If independently validated, the use of biomarkers may help to guide therapeutic decision making in transplant patients,” Dr Caillard’s team concluded.
Of the 494 KTRs (approximately 5% dual organ transplants) with COVID-19, 83% were admitted to the hospital and 30.6% of these were sent to an intensive care unit. Mechanical ventilation was required by 26% of the cohort. Overall, acute kidney injury occurred in 57.8%, and renal replacement therapy was initiated in 15.6%.
For immunosuppressive management, withdrawal of an antimetabolite or mTOR inhibitor occurred in 62.5% and 64.1%, respectively, of KTRs receiving these medications. Withdrawal of a calcineurin inhibitor or belatacept occurred in 32.4% and 46.1% of users, respectively.
Caillard S, Chavarot N, Francois H, et al; on behalf of the French SOT COVID Registry. Clinical utility of biochemical markers for the prediction of COVID-19-related mortality in kidney transplant recipients. Kidney Int Rep. Published online July 7, 2021. doi:10.1016/j.ekir.2021.06.034