Association Between Maintenance Immunosuppressive Regimens and COVID-19 Mortality in Kidney Transplant Recipients. Issue 10 (27th July 2022)

• Record Type: Journal Article
• Authors: Gérard, Alexandre O.; Barbosa, Susana; Anglicheau, Dany; Couzi, Lionel; Hazzan, Marc; Thaunat, Olivier; Blancho, Gilles; Caillard, Sophie; Sicard, Antoine
• Other Names: Caillard Sophie author non-byline.; Moulin Bruno author non-byline.; Fafi-Kremer Samira author non-byline.; Hazzan Marc author non-byline.; Anglicheau Dany author non-byline.; Hertig Alexandre author non-byline.; Tourret Jérôme author non-byline.; Barrou Benoit author non-byline.; Morelon Emmanuel author non-byline.; Thaunat Olivier author non-byline.; Couzi Lionel author non-byline.; Merville Pierre author non-byline.; Moal Valérie author non-byline.; Legris Tristan author non-byline.; Westeel Pierre-François author non-byline.; Jaureguy Maïté author non-byline.; Frimat Luc author non-byline.; Ducloux Didier author non-byline.; Bamoulid Jamal author non-byline.; Bertr Dominique author non-byline.; Tsimaratos Michel author non-byline.; Garaix-Gilardo Florentine author non-byline.; Dumortier Jérôme author non-byline.; Mussot Sacha author non-byline.; Roux Antoine author non-byline.; Sebbag Laurent author non-byline.; Le Meur Yannick author non-byline.; Blancho Gilles author non-byline.; Masset Christophe author non-byline.; Kamar Nassim author non-byline.; Francois Hélène author non-byline.; Rondeau Eric author non-byline.; Bouvier Nicolas author non-byline.; Mousson Christiane author non-byline.; Buchler Matthias author non-byline.; Gatault Philippe author non-byline.; Augusto Jean-François author non-byline.; Duveau Agnès author non-byline.; Vigneau Cécile author non-byline.; Morin Marie-Christine author non-byline.; Chemouny Jonathan author non-byline.; Golbin Leonard author non-byline.; Grimbert Philippe author non-byline.; Matignon Marie author non-byline.; Durrbach Antoine author non-byline.; Greze Clarisse author non-byline.; Snanoudj Renaud author non-byline.; Colosio Charlotte author non-byline.; Schvartz Betoul author non-byline.; Malvezzi Paolo author non-byline.; Mariat Christophe author non-byline.; Thierry Antoine author non-byline.; Le Quintrec Moglie author non-byline.; Sicard Antoine author non-byline.; Rerolle Jean Philippe author non-byline.; Heng Anne-Élisabeth author non-byline.; Garrouste Cyril author non-byline.; Coponat Henri Vacher author non-byline.; Epailly Éric author non-byline.; Brugiere Olivier author non-byline.; Dharancy Sébastien author non-byline.; Salame Éphrem author non-byline.; Saliba Faouzi author non-byline.;
• Is Part Of: Transplantation. Volume 106:Issue 10(2022)
• Page Start: 2063
• Page End: 2067
• Publication Date: 2022-07-27
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000004254
• Languages: English
• ISSNs: 0041-1337

Abstract

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. Abstract :