Article Dans Une Revue Kidney International Reports Année : 2022

Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients

1 HCL - Hospices Civils de Lyon
2 Service de Néphrologie et Transplantation rénale [CHRU-lille]
3 INFINITE - Institute for Translational Research in Inflammation - U 1286
4 Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
5 CHU Tenon [AP-HP]
6 IMRB - Institut Mondor de Recherche Biomédicale
7 Hôpital Henri Mondor
8 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
9 T2i - Transplantation, Immunologie, Inflammation [Tours]
10 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
11 Service de Néphrologie [CHRU Nancy]
12 Service de Néphrologie-Dialyse-Transplantation [CHU Amiens-Picardie]
13 CHU Montpellier = Montpellier University Hospital
14 Hôpital Foch [Suresnes]
15 CHU Reims - Hôpital universitaire Robert Debré [Reims]
16 Département de Néphrologie - Hôpital Pasteur [Nice]
17 Service de Néphrologie [Rouen]
18 Service de néphrologie (CHU de Dijon)
19 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
20 ImmunoConcept - Immunology from Concept and Experiments to Translation = Immunologie Conceptuelle, Expérimentale et Translationnelle
21 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
22 Irset - Institut de recherche en santé, environnement et travail
23 CIC - Centre d'Investigation Clinique [Rennes]
24 LBAI - Lymphocytes B, Autoimmunité et Immunothérapies
25 IRM - Immuno-Rhumatologie Moléculaire
26 CIRI - Centre International de Recherche en Infectiologie
27 CIRI-NOPAB - Cellules B normales et pathogéniques - Normal and pathogenic B cell responses [CIRI]
28 UCBL - Université Claude Bernard Lyon 1
29 Service de Transplantation, Néphrologie et Immunologie Clinique [Lyon]
Jamal Bamoulid
  • Fonction : Auteur
Paolo Malvezzi
  • Fonction : Auteur
Antoine Thierry
Agnes Duveau
  • Fonction : Auteur
Valerie Moal
  • Fonction : Auteur
Gilles Blancho
Jérôme Tourret
  • Fonction : Auteur
Christophe Mariat
Jean-Philippe Rerolle
  • Fonction : Auteur
Nicolas Bouvier
  • Fonction : Auteur

Résumé

Introduction - SARS-CoV-2 pandemic evolved in 2 consecutive waves during 2020. Improvements in the management of COVID-19 led to a reduction in mortality rates among hospitalized patients during the second wave. Whether this progress benefited kidney transplant recipients (KTRs), a population particularly vulnerable to severe COVID-19, remained unclear. Methods - In France, 957 KTRs were hospitalized for COVID-19 in 2020 and their data were prospectively collected into the French Solid Organ Transplant (SOT) COVID registry. The presentation, management, and outcomes of the 359 KTRs diagnosed during the first wave were compared to those of the 598 of the second wave. Results - Baseline comorbidities were similar between KTRs of the 2 waves. Maintenance immunosuppression was reduced in most patients but withdrawal of antimetabolite (73.7% vs. 58.4%,  < 0.001) or calcineurin inhibitor (32.1% vs. 16.6%,  < 0.001) was less frequent during the second wave. Hydroxychloroquine and azithromycin that were commonly used during the first wave (21.7% and 30.9%, respectively) but were almost abandoned during the second wave. In contrast, the use of high dose corticosteroids doubled (19.5% vs. 41.6%,  < 0.001). Despite these changing trends in COVID-19 management, 60-day mortality was not statistically different between the 2 waves (25.3% vs. 23.9%; Log Rank,  = 0.48) and COVID-19 hospitalization period was not associated with death due to COVID-19 in multivariate analysis (Hazard ratio 0.89, 95% confidence interval 0.67-1.17,  = 0.4). Conclusion - We conclude that changing of therapeutic trends during 2020 did not reduce COVID-19 related mortality among KTRs. Our data indirectly support the importance of vaccination and neutralizing monoclonal anti-SARS-CoV-2 antibodies to protect KTRS from severe COVID-19.

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hal-03800251 , version 1 (23-01-2023)
hal-03800251 , version 2 (23-01-2023)

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Bastien Berger, Marc Hazzan, Nassim Kamar, Hélène Francois, Marie Matignon, et al.. Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients. Kidney International Reports, 2022, 7 (12), pp.2617-2629. ⟨10.1016/j.ekir.2022.09.007⟩. ⟨hal-03800251v2⟩
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