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Daoud A, Soliman K, Posadas Salas MA, Uehara G, Vaishnav S, Cheungpasitporn W, Casey MJ. COVID-19 and renal allograft rejection: insight from controlled and non-controlled studies. Ren Fail 2024; 46:2336126. [PMID: 38627208 PMCID: PMC11022909 DOI: 10.1080/0886022x.2024.2336126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
AIM Kidney transplant recipients (KTRs), due to their immunosuppressed status, are potentially more susceptible to both the severe effects of COVID-19 and complications in their transplanted organ. The aim of this study is to investigate whether COVID-19 infection increases the risk of rejection in kidney transplant recipients (KTRs). METHODS This study involved a detailed literature review, conducted using PubMed, with the search being completed by September 7th, 2023. The search strategy incorporated a combination of relevant keywords: 'COVID', 'Renal', 'Kidney', 'Transplant', and 'Rejection'. The results from controlled and uncontrolled studies were separately collated and analyzed. RESULTS A total of 11 studies were identified, encompassing 1,179 patients. Among these, two controlled studies reported the incidence of rejection in KTRs infected with COVID-19. Pooling data from these studies revealed no significant statistical correlation between COVID-19 infection and biopsy-proven rejection (p = 0.26). In addition, nine non-controlled studies were found, with rejection incidences ranging from 0% to 66.7%. The majority of these studies (eight out of nine) had small sample sizes, ranging from 3 to 75 KTRs, while the largest included 372 KTRs. The combined rejection rate across these studies was calculated to be 11.8%. CONCLUSION In conclusion, the limited number of published controlled studies revealed no statistically significant association between COVID-19 infection and biopsy-proven rejection among KTRs. However, the broader analysis of non-controlled studies showed a variable rejection incidence with a pooled rejection rate of 11.8%. There is insufficient high-quality data to explore the association of COVID-19 infection and rejection.
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Affiliation(s)
- Ahmed Daoud
- Medical University of South Carolina, Charleston, SC, USA
- Division of Nephrology, Cairo University Medical School, Cairo, Egypt
| | - Karim Soliman
- Medical University of South Carolina, Charleston, SC, USA
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Genta Uehara
- Medical University of South Carolina, Charleston, SC, USA
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Kute VB, Pathak V, Ray DS, Bhalla AK, Godara SM, Narayanan S, Hegde U, Das P, Jha PK, Kher V, Dalal S, Bahadur MM, Gang S, Sinha VK, Patel HV, Deshpande R, Mali M, Sharma A, Das SS, Thukral S, Shingare A, Bt AK, Hafeeq B, Aziz F, Aboobacker IN, Gopinathan JC, Dave RM, Bansal D, Anandh U, Singh S, Kriplani J, Bavikar S, Siddini V, Balan S, Singla M, Chauhan M, Tripathi V, Patwari D, Abraham AM, Chauhan S, Meshram HS. A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India. Transplantation 2024; 108:545-555. [PMID: 37641175 DOI: 10.1097/tp.0000000000004789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. METHODS Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). RESULTS Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. CONCLUSIONS Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
- Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, Delhi, India
| | - Suraj M Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Sajith Narayanan
- Department of Nephrology, Aster MIMS Hospital, Kozhikode, Kerala, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Pratik Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vijay Kher
- Department of Nephrology and Transplant Medicine, Epitome Kidney and Urology Institute, Epitome Hospital, New Delhi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | | | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
- Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Manish Mali
- Department of Nephrology, Aditya Birla Memorial Hospital, Chinchwad, Pune, Maharashtra, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushree Sashmita Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Anil Kumar Bt
- Department of Nephrology, BGS Global Hospital, Bengaluru, Karnataka, India
| | - Benil Hafeeq
- Department of Nephrology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | - Feroz Aziz
- Department of Nephrology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | | | - Jyotish Chalil Gopinathan
- Department of Nephrology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | - Rutul M Dave
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad, Delhi, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai Kriplani
- Department of Nephrology, Choithram Hospital and Research Center, Indore, Madhya Pradesh, India
| | - Suhas Bavikar
- Department of Nephrology, MIT Hospital and Research Institute, Aurangabad, Maharashtra, India
| | | | - Satish Balan
- Department of Nephrology, KIMS Hospital Anayara, Thiruvananthapuram, Kerala, India
| | - Manish Singla
- Department of Nephrology, Max Super Specialty Hospital, Mohali, India
| | - Munish Chauhan
- Department of Nephrology, Max Super Specialty Hospital, Mohali, India
| | | | - Devang Patwari
- Department of Nephrology, Zydus Hospitals, Ahmedabad, Gujarat, India
| | - Abi M Abraham
- Department of Nephrology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
- Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
- Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Kute VB, Chauhan S, Ray DS, Hegde U, Sinha VK, Das SS, Godara S, Anandh U, Gulati S, Goswami J, Dalal S, Babu K, Siddini V, Patil M, Meshram HS. Is it safe to undergo living donor kidney transplant within 2 weeks following COVID-19? THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100254. [PMID: 38028167 PMCID: PMC10667304 DOI: 10.1016/j.lansea.2023.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Deepak Shankar Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Vijay Kumar Sinha
- Department of Nephrology, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Sushree Sashmita Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences (RNTIICS), Kolkata, West Bengal, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Urmila Anandh
- Department of Nephrology, Amrita Hospital, Faridabad, Uttar Pradesh, India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India
| | - Jitendra Goswami
- Department of Nephrology, Manipal Hospitals, Jaipur, Rajasthan, India
| | - Sonal Dalal
- Department of Nephrology, Sterling Hospital, Ahmedabad, Gujarat, India
| | - Kishor Babu
- Department of Nephrology, Manipal Hospital, Bangalore, Karnataka, India
| | | | - Mayur Patil
- Department of Nephrology, CIMS Hospital, Ahmedabad, Gujarat, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
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