A Retrospective Study Comparing Mortality Rates between Vaccinated and Unvaccinated Kidney Transplant Recipients


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Abstract

Background:With the emergence of vaccines for COVID-19, mortality and severity of disease have decreased. However, patients with certain comorbidities, such as immunosuppression, CKD, and renal transplant, still have higher mortality rates as compared to the general population. Current data suggests that the risk of developing COVID-19 among transplant patients was reported to be about 5%, which is significantly higher than the risk rate of 0.3% in the general population. Studies utilizing larger sample sizes (i.e., multiple cohorts, sites, hospitals) comparing COVID-19 outcomes among renal transplant patients with a control group are lacking.

background:Coronaviruses belong to a family of Viruses that can cause range of illnesses ranging from the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (1,2). In 2019 a new Coronavirus was identified and was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) which belongs to the genus beta-CoV which also includes Severe Acute Respiratory Syndrome CoV (SARS-CoV), and Middle Eastern Respiratory Syndrome CoV (MERS-CoV) (2). World Health Organization (WHO) later announced an alternative name for the disease caused by SARS-CoV-2: CoV disease (COVID-19) (2). As of May 25, 2022 an estimated 524,339,768 cases of COVID-19 were reported to World health organization including 6,281,260 deaths related to COVID globally. However, the disease affects patients with certain risk factors disproportionally. Recent data has shown chronic comorbidities, such as acute kidney injury, COPD, diabetes, hypertension, CVD, cancer, increased D-dimer, along with demographic variables such as male gender, older age, current smoker, and obesity are clinical risk factors for a fatal outcome associated with coronavirus [3]. With the emergence of COVID-19 vaccines, severity and mortality of the disease decreased and has contributed in controlling the pandemic that has claimed so many lives across the globe (4). Even with the emergence of vaccine, the disease continued to claim a disproportionate number of lives, particularly among immunocompromised individuals

Objective:The purpose of this descriptive study was to compare the mortality rate between vaccinated and unvaccinated kidney transplant recipients.

objective:The purpose of this study is to provide a descriptive overview of clinical outcomes between vaccinated and unvaccinated kidney transplant recipients in a single transplant center in West Texas

Methods:Participants were recruited at a community-based transplant clinic in West Texas. Results Among the group of participants who tested positive for COVID-19 between 2020 and 2022, higher mortality rates and longer hospital stays were noted among those unvaccinated (72% unvaccinated had greater than 5-day length of stay vs. 33% vaccinated).

method:Retrospective Data was collected from Kidney Transplant Clinic at a Medical Center located in El Paso, Texas. Data was gathered between January 2020 and January 2022 from the transplant database. Data was extrapolated for demographics including age, race, gender. Other data included vaccinated vs. unvaccinated status, comorbidities, immunosuppression status, outcomes such as length of stay in the hospital and mortality rate. A total of 38 patients were included in the study between the year 2020 and 2022. In cases where the patient died, missing data was collected from the next of kin. Inclusion criteria included aged 18 and older, being a kidney transplant recipient (deceased and living) and had a current functioning transplanted kidney. We included all patients who tested positive for COVID-19 during January 2020 to December 2022. Patient whose data could not be obtained since they were deceased and/or did not have next of kin were excluded from the study. Patients were also excluded from the study if their missing data could not be obtained or validated by patient or next of kin.

Conclusion:Our study suggests that vaccination against COVID-19 decreases mortality rates in kidney transplant recipients.

result:Among the 38 patients included in the data set 94.7% identified as Hispanic vs 5.2% were non-Hispanics and 71% were male vs 28.9% were females. The majority of the patients were vaccinated (71% vs 28.9% non-vaccinated). The data also showed higher rates of death in Unvaccinated population as opposed to vaccinated patients (90.9% vs 14.8%). 72% of unvaccinated transplant recipients had a length of stay greater than 5 days compared to 33% of vaccinated patients. All of the patients evaluated in the cohort had two or more comorbidities such as HTN, atrial fibrillation and DM2 (100%). Among patients included in the cohort 84.2% were deceased renal transplant recipients while 15.7% living renal transplant recipients. Furthermore, increased mortality rates were seen among patients treated with higher induction doses (greater than 350mg). A total of 20 patients in the cohort received greater than 350 mg of induction doses out of which 9 were unvaccinated (45%) and 12 were vaccinated (60%). Out of the 9 unvaccinated patients 8 patients died (88%) while 1 patient survived (11.1). Respiratory failure was the main cause of death among patients that passed away, regardless of vaccine status (90.9% Vaccinated vs 14.8% unvaccinated).

conclusion:Large phase 3 clinical trials are still currently underway worldwide to study the effects of vaccine on transplant patient. Our study suggests that vaccination against COVID 19 decreases mortality rates in Kidney Transplant recipient. Our retrospective study compared mortality rates between vaccinated and unvaccinated Kidney transplant recipients in a small clinic setting. It is important to have a large prospective double-blind study on the use of vaccinations in renal transplant recipients would be useful to study the effectiveness on this population.

About the authors

Anaam Fayyaz

Internal Medicine Resident Physician, HCA Las Palmas Del Sol Medical Center

Author for correspondence.
Email: info@benthamscience.net

Judy Pozzerle

Quality Coordinator Transplant Services, Las Palmas Medical Center

Email: info@benthamscience.net

Suresh Antony

Clinical Prof. of Medicine, Texas Tech University Health Sciences Center

Email: info@benthamscience.net

References

  1. Angelico R, Blasi F, Manzia TM, Toti L, Tisone G, Cacciola R. The management of immunosuppression in kidney transplant recipients with COVID-19 Disease: An update and systematic review of the literature. Medicina 2021; 57(5): 435. doi: 10.3390/medicina57050435 PMID: 33946462
  2. Bhojraj S, Ochani A, Rajgopal S. Lifetime earnings. SSRN Elec J 2021. doi: 10.2139/ssrn.3951530
  3. Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: A systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis 2021; 21(1): 855. doi: 10.1186/s12879-021-06536-3 PMID: 34418980
  4. Singson JRC, Kirley PD, Pham H, et al. Factors associated with severe outcomes among immunocompromised adults hospitalized for COVID-19 — COVID-NET, 10 States, March 2020–February 2022. MMWR Morb Mortal Wkly Rep 2022; 71(27): 878-84. doi: 10.15585/mmwr.mm7127a3 PMID: 35797216
  5. Alexander GC, Sehgal AR. Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA 1998; 280(13): 1148-52. doi: 10.1001/jama.280.13.1148 PMID: 9777814
  6. Held PJ, Pauly MV, Bovbjerg RR, Newmann J, Salvatierra O Jr. Access to kidney transplantation. Has the United States eliminated income and racial differences? Arch Intern Med 1988; 148(12): 2594-600. doi: 10.1001/archinte.1988.00380120056011 PMID: 3058072
  7. Amanda J. Vinson gender disparities in access to kidney transplant. Inequit Inequit Kidney Int Reports 2022; 7(6): 1145-8. PMID: 35694565
  8. Caillard S, Chavarot N, Francois H, et al. Is COVID-19 infection more severe in kidney transplant recipients? Am J Transplant 2021; 21(3): 1295-303. doi: 10.1111/ajt.16424 PMID: 33259686
  9. Akalin E, Azzi Y, Bartash R, et al. Covid-19 and kidney transplantation. N Engl J Med 2020; 382(25): 2475-7. doi: 10.1056/NEJMc2011117 PMID: 32329975
  10. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97(5): 829-38. doi: 10.1016/j.kint.2020.03.005 PMID: 32247631
  11. Elhadedy MA, Marie Y, Halawa A. COVID-19 in renal transplant recipients: Case series and a brief review of current evidence. Nephron 2020145(2): 1-7. doi: 10.1159/000512329
  12. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382(18): 1708-20. doi: 10.1056/NEJMoa2002032 PMID: 32109013
  13. Cucchiari D, Egri N, Bodro M, et al. Cellular and humoral response after MRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients. Am J Transplant 2021; 21(8): 2727-39. doi: 10.1111/ajt.16701 PMID: 34036720
  14. Azzi Y, Bartash R, Scalea J, Loarte-Campos P, Akalin E. COVID-19 and solid organ transplantation: A review article. Transplantation 2021; 105(1): 37-55. doi: 10.1097/TP.0000000000003523 PMID: 33148977
  15. Abu Jawdeh BG. COVID-19 in kidney transplantation: Outcomes, immunosuppression management, and operational challenges. Adv Chronic Kidney Dis 2020; 27(5): 383-9. doi: 10.1053/j.ackd.2020.07.004 PMID: 33308503
  16. Simone S, Pesce F, Fontò G, et al. Kinetics of humoral immune response and severity of infection after three doses of SARS-CoV-2 mRNA vaccine in a large cohort of kidney transplant recipients. J Nephrol 2023; 36(6): 1663-71. doi: 10.1007/s40620-023-01650-8 PMID: 37458909
  17. Pezzuto A, Tammaro A, Tonini G, Ciccozzi M. COPD influences survival in patients affected by COVID-19, comparison between subjects admitted to an internal medicine unit, and subjects admitted to an intensive care unit: An Italian experience. J Med Virol 2021; 93(3): 1239-41. doi: 10.1002/jmv.26585 PMID: 33026657
  18. Pezzuto A, Tammaro A, Tonini G, et al. SARS-Cov-2 pneumonia and concurrent myelodysplasia complicated by Pseudomonas aeruginosa over-infection. J Virol Methods 2022; 300: 114419-9. doi: 10.1016/j.jviromet.2021.114419 PMID: 34896451

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