Migratory pattern of the coronavirus disease 2019 and high fatality rates among kidney transplant recipients: report from the Brazilian Multicenter Cohort Study

Abstract Introduction: The unprecedented coronavirus disease 2019 (COVID-19) pandemic has affected kidney transplant (KT) recipients, with worldwide fatality rates around 25%. Considering the well-known Brazilian socio-demographic disparities, this report describes for the first time the main outcomes of COVID-19 in KT recipients according to Brazilian geographic regions. Methods: This multicenter national retrospective analysis included data from KT recipients with confirmed COVID-19 between March and November 2020. Results: Thirty-five of the 81 centers (57% of KT activity in Brazil) reported 1,680 patients with COVID-19. The Northeast was the first to reach the peak in the number of infections. The Southeast, due to its population density, contributed with the largest number of patients. Patients had a median age of 52 years, 76% had hypertension and 34% diabetes, 75% were recipients of a deceased donor, and the time interval between diagnosis and transplantation was 5.9 years. In 53% of patients, immunosuppression was adjusted, and clinical support varied according to geographic region. Hospitalization was required for 65% of the patients, 35% of them needed intensive care, 25% mechanical ventilation, and 23% renal replacement therapy. The 90-day overall fatality was 21%, being 23% in the Southeast, 16% in the Northeast, and 19% in the Central-west and South regions. Conclusion: The migratory pattern of the pandemic among KT recipients followed that of the general population and the outcomes were influenced by regional features. COVID-19 in KT recipients was associated with high utilization of health-care resources and higher fatality rates than those reported in the general population.

引言：史无前例的新型冠状病毒肺炎（Coronavirus Disease 2019, COVID-19）大流行对肾移植（Kidney Transplant, KT）受者造成了严重影响，全球范围内其病死率约为25%。鉴于巴西存在显著的社会人口学差异，本研究首次针对巴西不同地理区域的肾移植受者，报告其感染COVID-19后的主要临床结局。
方法：本项多中心全国性回顾性研究纳入了2020年3月至11月期间确诊感染COVID-19的肾移植受者相关数据。
结果：巴西81家肾移植中心中有35家参与本研究（覆盖全国57%的肾移植诊疗活动），共纳入1680例确诊COVID-19的肾移植受者。东北部地区是首个达到感染峰值的区域；东南部地区因人口密度较高，纳入的患者数量最多。研究对象的中位年龄为52岁，其中76%合并高血压、34%合并糖尿病，75%为尸体供肾受者，肾移植术后至确诊COVID-19的中位时间间隔为5.9年。53%的患者调整了免疫抑制治疗方案，不同地理区域的临床支持措施存在差异。65%的患者需接受住院治疗，其中35%需要重症监护、25%需要机械通气、23%需要肾脏替代治疗。研究对象的90天总体病死率为21%：东南部地区为23%，东北部地区为16%，中西部与南部地区为19%。
结论：肾移植受者感染COVID-19后的大流行传播模式与普通人群一致，其临床结局受区域特征影响。相较于普通人群，肾移植受者感染COVID-19后医疗资源占用率更高，病死率也更高。