Abstract
Background: Solid organ transplant recipients are at high risk for fatal forms of coronavirus disease 2019 (COVID-19). We conducted a cohort study among kidney transplant (KT) recipients from the French Solid Organ Transplant COVID-19 Registry to investigate the association between maintenance immunosuppressive drugs and 60-d mortality.
Methods: Data from all KT recipients with COVID-19 included in the French Solid Organ Transplant COVID-19 Registry between February 28, 2020, and December 30, 2020, were retrieved. We evaluated associations between immunosuppressive drugs and death within 60 d using logistic regression, with all baseline characteristics considered to influence outcome or immunosuppressive regimen. The Benjamini-Hochberg correction was used for controlling false positive rate; 40 multiple imputations were performed. Adjusted P value <0.05 was considered statistically significant.
Results: There were 1451 KT recipients included. Median age was 58 y, and 66.4% were men. Most frequent comorbidities were hypertension (81.9%), diabetes (34.5%), and cardiovascular disease (29.5%). Median time since transplant was 71 mo. Maintenance immunosuppression regimens included calcineurin inhibitors (1295, 89.2%), antimetabolites (1205, 83%), corticosteroids (1094, 75.4%), mammalian target of rapamycin inhibitors (144, 9.9%), and belatacept (58, 4.0%). Among 1451 transplant recipients, 201 (13.9%) died within 60 d. Older age and higher baseline serum creatinine were associated with mortality (odds ratios, 1.09 [1.07-1.11] and 1.01 [1.005-1.009], P < 0.001). Corticosteroid-free regimens were associated with a significantly lower risk of death (odds ratio, 0.48 [0.31-0.76]; P = 0.011).
Conclusions: Corticosteroid-free regimens were associated with a lower risk of death in KT recipients with COVID-19. Long-term exposure to corticosteroids impairs immune functions and may predispose solid organ transplant recipients to severe forms of COVID-19.
Trial registration: ClinicalTrials.gov NCT04360707 .
【초록키워드】 Corticosteroid, COVID-19, coronavirus disease, Mortality, Immunosuppression, Comorbidity, cardiovascular disease, outcome, hypertension, cohort study, Rapamycin, Transplant, death, Logistic regression, immune function, age, registry, inhibitor, False positive, kidney transplant, solid organ transplant, association, Odds ratio, immunosuppressive, solid organ, high risk, maintenance, regimen, p value, risk of death, serum creatinine, multiple imputation, baseline characteristics, recipients, lower risk, French, recipient, MOST, significantly lower, mammalian, men, performed, was used, died, evaluated, form, conducted, statistically significant, impair, diabete, baseline, immunosuppressive drug, retrieved, Solid, with COVID-19, 【제목키워드】 COVID-19, Transplant, maintenance, recipient,