Follow-up status after recovery from COVID-19 infection in kidney transplant recipients: a single center experience from India across various pandemic waves
Hari Shankar Meshram1, Sanshriti Chauhan1, Nauka Shah1, Vivek Kute1, Himanshu Patel1, Ruchir Dave1, Vineet Mishra1.
1Nephrology and Transplantation, Institute of kidney disease and research center, institute of transplantation sciences, Ahmedabad, India
Introduction: There are dearth of knowledge for the follow-up studies with regards to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in kidney transplant recipients (KTR). We have previously reported first such report of a small cohort. Herein we analyse long term outcome of COVID-19 infection in KTR across different pandemic waves including delta and omicron wave.
Methods: We conducted this retrospective, single center cohort study of hospitalized (n = 367) and non-hospitalized KTR (n = 197) for a median (range) follow-up of 14 (1-20) months who recovered from SARS-CoV-2 during May 2020 to Jan 2022. All confirmed RT-PCR cases with at least 3-month follow-up were included. The outcomes measured were persistent symptoms post-discharge; EuroQoL visual analogue score (EQ-VAS); EuroQoL 5-dimension score (E5-QD-5L) score and modified medical research dyspnea score (mMRC) at discharge, 3 months and last follow-up. Other outcomes were graft outcome and postulated COVID-19 sequelae.
Results: The median(range) age of the cohort was 44 (15-71) years and COVID-19 severity ranged from asymptomatic (14%), mild (40%), moderate (36%) to severe (10%). The most common persistent symptom was generalized which significantly decreased in the follow-up (n = 110 vs. 53 vs. 11]; p-value = 0.0001) at discharge, 3-month, and last follow-up respectively. Decrement in the mean (standard deviation) EQ-VAS score from baseline was also improved (36 [13] vs. 17 [12.5] vs. 8 [12.0]; p-value < 0.0001). There was statistically significant improvement in all EQ-5D-5L scores in follow-up. There was no deterioration in mMRC scores during the follow-up Moderate- severe cases had significantly poorer overall scores initially, but there was no difference at long term follow-up. 27 of 30 graft losses reported had baseline chronic graft dysfunction at baseline. There were no unexplained deaths, pulmonary fibrosis, cardiovascular event or cerebrovascular event.
Conclusion: We report the largest cohort of Indian transplant recipients with COVID-19 at longest follow-up. Improvement in quality of life and no postulated COVID-19 sequelae ensures that no residual abnormality exist in post-COVID-19 KTR.
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