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Bhagat C, Gurnani N, Godara S, Mathur R, Goel A, Meshram HS. A Retrospective and Comparative Analysis of Clinical Outcomes of Kidney Transplant Recipients During First and Second COVID-19 Waves in North-West India. Cureus 2024; 16:e51693. [PMID: 38313994 PMCID: PMC10838483 DOI: 10.7759/cureus.51693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Kidney transplant recipients (KTRs) are prone to coronavirus disease 2019 (COVID-19) disease secondary to chronic immunosuppressive therapy. There have been differences in mortality and morbidity amongst the general population with different COVID-19 waves. This study is done to understand the effects of different COVID-19 waves amongst KTRs. Methods This was a retrospective single-centre trial from a high-volume transplant centre in North India. The immunosuppression protocol was changed according to national guidelines, and predictors of survival were evaluated. Results A total of 62 patients got infected during the first COVID-19 wave (March 2020 to February 2021) and 50 patients during the second COVID-19 wave (March 2021 to December 2021). Analysis showed a higher incidence of severe COVID-19 disease (79% vs. 50%) in the first wave, while the rest of the baseline parameters were similar in both waves. Mortality was similar in both groups. In both groups, severe COVID-19 disease, the requirement of hospitalisation, invasive oxygen therapy, and CT score findings were significant predictors of survival. There was no change in survival with respect to immunosuppression modification. Allograft dysfunction was more common in the second wave (7 vs. 1). Baseline creatinine was significantly associated with allograft dysfunction in follow-up. Conclusion Patients had severe COVID-19 disease during the first wave; however, poor availability of healthcare services during the second wave led to more patients with allograft dysfunction. Though immunosuppression change is necessary to prevent flare-ups of COVID-19 infection, it is not associated with survival benefits.
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Affiliation(s)
- Chandani Bhagat
- Nephrology, Institute of Liver and Biliary Sciences, New Delhi, IND
| | - Nishant Gurnani
- Urology, Employees' State Insurance Corporation (ESIC) Hospital, Faridabad, IND
| | - Suraj Godara
- Nephrology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, IND
| | - Rajan Mathur
- Nephrology, Institute of Liver and Biliary Sciences, New Delhi, IND
| | - Ankur Goel
- Nephrology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Abstract
The acute coronavirus disease-2019 (COVID-19) pandemic has had a significant impact on the incidence and prevalence of acute kidney injury and chronic kidney disease globally and in low-income settings. Chronic kidney disease increases the risk of developing COVID-19 and COVID-19 causes acute kidney injury directly or indirectly and is associated with high mortality in severe cases. Outcomes of COVID-19-associated kidney disease were not equitable globally owing to a lack of health infrastructure, challenges in diagnostic testing, and management of COVID-19 in low-income settings. COVID-19 also significantly impacted kidney transplant rates and mortality among kidney transplant recipients. Vaccine availability and uptake remains a significant challenge in low- and lower-middle-income countries compared with high-income countries. In this review, we explore the inequities in low- and lower-middle-income countries and highlight the progress made in the prevention, diagnosis, and management of patients with COVID-19 and kidney disease. We recommend further studies into the challenges, lessons learned, and progress made in the diagnosis, management, and treatment of patients with COVID-19-related kidney diseases and suggest ways to improve the care and management of patients with COVID-19 and kidney disease.
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Kute VB, Rela M, Abraham G, Gulati S, Bhalla AK, Chauhan S, Mishra VV, Meshram HS. A Narrative Review COVID-19 in Solid-Organ Transplantation: Real-World Evidence From India. EXP CLIN TRANSPLANT 2022; 20:32-42. [PMID: 36018018 DOI: 10.6002/ect.donorsymp.2022.l21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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4
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Vart P, Jager KJ, Arnol M, Duivenvoorden R, Franssen CFM, Groeneveld M, Hemmelder MH, Lepeytre F, Malfait T, Midtvedt K, Mitra S, Facundo C, Noordzij M, Reina CC, Safak S, Toapanta N, Hilbrands LB, Gansevoort RT. COVID-19 pandemic waves and mortality among patients on kidney replacement therapy. Kidney Int Rep 2022; 7:2091-2096. [PMID: 35757188 PMCID: PMC9213008 DOI: 10.1016/j.ekir.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Priya Vart
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Center Ljubljana; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casper F M Franssen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Marc H Hemmelder
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre; CARIM school for cardiovascular research, University Maastricht, Maastricht, Netherlands
| | - Fanny Lepeytre
- Claude Galien Hospital Ramsay santé, Quincy-sous-Sénart, France
| | | | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Olso, Norway
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, University of Manchester, UK
| | | | - Marlies Noordzij
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Seda Safak
- Division on Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ron T Gansevoort
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India. Int J Nephrol 2022; 2022:9088393. [PMID: 35669496 PMCID: PMC9165617 DOI: 10.1155/2022/9088393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/07/2022] [Indexed: 01/08/2023] Open
Abstract
Data comparing the clinical spectrum of COVID-19 in kidney transplant recipients (KTRs) during the first and second waves of the pandemic in India is limited. Our single-center retrospective study compared the clinical profile, mortality, and associated risk factors in KTRs with COVID-19 during the 1st wave (1st February 2020 to 31st January 2021) and the second wave (1st March-31st August 2021). 156 KTRs with PCR confirmed SARS-CoV-2 infection treated at a tertiary care hospital in New Delhi during the 1st and the second waves were analyzed. The demographics and baseline transplant characteristics of the patients diagnosed during both waves were comparable. Patients in the second wave reported less frequent hospitalization, though the intensive care unit (ICU) and ventilator requirements were similar. Strategies to modify immunosuppressants such as discontinuation of antinucleoside drugs with or without change in calcineurin inhibitors and the use of steroids were similar during both waves. Overall patient mortality was 27.5%. The demographics and baseline characteristics of survivors and nonsurvivors were comparable. A higher percentage of nonsurvivors presented with breathing difficulty, low SpO2, and altered sensorium. Both wave risk factors for mortality included older age, severe disease, ICU/ventilator requirements, acute kidney injury (AKI) needing dialysis, Chest Computerized Tomographic (CT) scan abnormalities, and higher levels of inflammatory markers particularly D-dimer and interleukin-6 levels. Conclusions. KTRs in both COVID-19 waves had similar demographics and baseline characteristics, while fewer patients during the second wave required hospitalization. The D-dimer and IL-6 levels are directly correlated with mortality.
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6
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Vashishtha C, Bhardwaj A, Diwaker A, Sharma S, Sharma MK, Sarin S. Collateral Impact on Patients of Liver Diseases in the Second COVID-19 Wave: A Retrospective Cohort Study. Cureus 2022; 14:e25542. [PMID: 35800810 PMCID: PMC9246352 DOI: 10.7759/cureus.25542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/27/2022] Open
Abstract
Background The second wave of the COVID-19 pandemic in India started in April 2021. This necessitated a change in focus from chronic ailments. This wave lasted till May 2021. Its impact on liver disease patients without COVID-19 infection has not been analyzed. Methods Records of liver disease patients from the Institute database admitted from April to May 2021 were compared with that from April to May 2019 i.e., prior to the pandemic. The primary outcome was a comparison of in-hospital mortality rates. Secondary outcomes were a comparison of 30 and 90-day readmission rates and liver transplantation rates. Results Seven hundred and seventy-one patients in April-May 2019 (group 1) and 545 patients in April-May 2021 (group 2) were analyzed. Patients in group 2 were sicker with higher PT (INR), urea, creatinine, CTP, and MELD score and low serum sodium, albumin, and platelet count with a higher prevalence of variceal bleed, hepatic encephalopathy, and acute kidney injury. There was higher mortality in group 2 (128/545; 23.5%) than group 1 (124/ 771;16.1%), OR 1.6, 95% CI 1.2 - 2.1, p<0.01. 30 day readmission rate was numerically higher in group1; 18.3% vs 16.9%, p=0.5. The 31-90 day readmission rate was higher in group 1; 29.4% vs 16.9%, p<0.01. There was no significant difference in the number of patients undergoing liver transplantation in two groups, 19 in group 1 and 14 in group 2 (p=0.90). Conclusion The second wave of the COVID-19 pandemic had a significant collateral impact on liver disease patients even without causing infection in them. Patients were sicker at the time of admission with higher mortality.
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Demir E, Ucar ZA, Dheir H, Danis R, Yelken B, Uyar M, Parmaksiz E, Artan AS, Sinangil A, Merhametsiz O, Yadigar S, Dirim AB, Akin B, Garayeva N, Safak S, Turkmen A. COVID-19 in Kidney Transplant Recipients: A Multicenter Experience from the First Two Waves of Pandemic. BMC Nephrol 2022; 23:183. [PMID: 35550025 PMCID: PMC9097147 DOI: 10.1186/s12882-022-02784-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. METHODS Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. RESULTS Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47-66]), first- (56 mL/min [IQR, 51-68]), third- (51 mL/min [IQR,48-67]) and sixth-months (52 mL/min [IQR, 48-81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. CONCLUSIONS Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.
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Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zuhal Atan Ucar
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ramazan Danis
- Department of Internal Medicine, Division of Nephrology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Berna Yelken
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Murathan Uyar
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Sinangil
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Department of Internal Medicine, Division of Nephrology, T.C. Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Serap Yadigar
- Department of Internal Medicine, Division of Nephrology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Akin
- Department of Internal Medicine, Division of Nephrology, Florence Nightingale Hospital, Bilim University, Istanbul, Turkey
| | - Nurana Garayeva
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Internal Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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8
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Kute VB, Meshram HS, Chauhan S, Shah N, Patel AH, Patel HV, Engineer D, Banerjee S, Dave R, Mishra VV. COVID-19 Pandemic Research Opportunities in India: What the Pandemic Is Teaching Us About Transplantation. EXP CLIN TRANSPLANT 2022; 20:10-16. [PMID: 35384801 DOI: 10.6002/ect.mesot2021.l18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease (COVID-19) has engulfed the whole world, and India has been the second worst-hit nation. Organ transplant services were halted in both the public and private care sectors of India, with public care sectors more adversely affected. Deceased donations were disproportionately more affected, with unfavorable rates at the peak of the pandemic. Mortality outcomes of COVID-19 among different organ transplant recipients in India have been lower compared with the Western world, with younger age and less comorbidities among Indian populations partly responsible for the lower mortality. Mortality and graft loss were mostly associated with older age and those with chronic graft dysfunction. During the pandemic, invasive fungal infections, like mucormycosis, have been reported, illustrating the need for multidisciplinary management. The Indian transplant societies have formulated and timely revised guidelines for transplantation in the COVID-19 era. Living donor transplants (both liver and kidney) after recovery from COVID-19 were both first described in India, providing a guiding tool for the world. Follow-up reports of recovered solid-organ transplant recipients have also been reported in Indian studies, showing reassuring long-term outcomes. Data of breakthrough COVID-19 cases after vaccination among both transplant recipients and waitlist candidates and research in vaccine efficacy for solid-organ transplant recipients is still underway. We suggest continuing and intensifying research activities for a better plan and strategy in case of a future pandemic.
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Affiliation(s)
- Vivek B Kute
- From the Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
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9
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Kute VB, Ray DS, Aziz F, Godara SM, Hegde U, KumarBT A, Bhalla AK, Yadav DK, Singh S, Pathak V, Dalal S, Bahadur MM, Anandh U, Abraham M A, Siddini V, Das SS, Thukral S, Krishnakumar A, Sharma A, Kher V, Bansal SB, Shingare A, Narayanan R, Patel H, Gulati S, Kakde S, Bansal D, Guleria S, Khullar D, Gumber MR, Varyani U, Guditi S, Khetan P, Dave R, Mishra VV, Tullius SG, Chauhan S, Meshram HS. Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study. EClinicalMedicine 2022; 46:101359. [PMID: 35350707 PMCID: PMC8948372 DOI: 10.1016/j.eclinm.2022.101359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). Methods We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. Findings Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. Interpretation Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. Funding Sanofi.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Deepak S. Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Feroz Aziz
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Suraj M. Godara
- Department of Nephrology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Anil KumarBT
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Pathak
- Department of nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Madan M. Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Abi Abraham M
- Department of Nephrology, VPS Lakeshore Hospital, Kochi, India
| | | | - Sushree Sashmita Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arvind Krishnakumar
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Shyam B. Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ranjit Narayanan
- Department of Nephrology, IQRAA International Hospital and Research Centre Calicut, Kozhikode, Kerala, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Sanjeev Gulati
- Department of Nephrology, Fortis Group of Hospitals, New Delhi, India
| | | | - Dinesh Bansal
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Dinesh Khullar
- Department of Nephrology, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Manoj R. Gumber
- Department of Nephrology, Indraprastha Apollo Hospital, Ahmedabad, Gujarat, India
| | - Umesh Varyani
- Department of Nephrology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Swarnalatha Guditi
- Department of Nephrology, Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, India
| | - Prakash Khetan
- Department of Nephrology, Kingsway Hospitals, Nagpur, India
| | - Rutul Dave
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, Gujarat, India
| | - Vineet V. Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Stefan G. Tullius
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat 380016, India
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10
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Jasuja S, Jha V, Sagar G, Bahl A, Verma S, Jasuja N, Kaur J. Post vaccination analysis of anti-spike antibody responses in kidney transplant recipients with and without COVID-19 infection in a tertiary care center, India. Clin Kidney J 2022; 15:1312-1321. [PMID: 35747093 PMCID: PMC8903484 DOI: 10.1093/ckj/sfac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To investigate the anti-spike antibody response to vaccination in Kidney transplant recipients (KTRs) previously infected with SARS-CoV-2 as compared to KTRs with no history of COVID-19 from India.
Methods
SARS-CoV-2 spike immunoglobulin (Ig) G antibody response was measured in 105 post COVID-19 KTRs with PCR confirmed SARS-CoV-2 infection who received either no vaccination (cohort 1), single (cohort 2) or two doses (cohort 3) of vaccine and compared to 103 two-dose vaccinated COVID-19 naïve KTRs with no history of COVID-19 (cohort 4).
Results
Out of 103 COVID-19 naïve two-dose vaccinated KTRs, less than 50% became seropositive with anti-spike antibody titres > 50AU/mL subsequent to complete vaccination, the seroconversion rate being comparable in subjects receiving CovishieldTM versus CovaxinTM vaccines. However, the seropositive KTRs vaccinated with CovishieldTM had higher anti-spike antibody titres as compared to those who received CovaxinTM. We observed higher anti-SARS-CoV-2 spike antibody levels in post COVID-19 KTRs after 1 dose of vaccine as compared with COVID-19 naïve two-dose vaccinated KTRs. Importantly, the second dose in post COVID-19 KTRs did not significantly increase anti-spike antibody levels compared with the single dose recipients.
Conclusions
Our data presents that in KTRs with previous SARS-CoV-2 infection a single dose of vaccine (CovishieldTM) may be effective in mounting optimal immune response. In contrast, COVID-19 naïve two-dose vaccinated KTRs respond poorly (<50%) to current recommendation of a two-dose regimen in India.
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Affiliation(s)
- Sanjiv Jasuja
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Gaurav Sagar
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Anupam Bahl
- Indraprastha Apollo Hospital, Department Of Nephrology, New Delhi, India
| | - Shalini Verma
- AVATAR Foundation, Department of Clinical Research, New Delhi, India
| | - Neharita Jasuja
- AVATAR Foundation, Department of Clinical Research, New Delhi, India
| | - Jasmeet Kaur
- Dr Lal PathLabs Ltd, National Reference Laboratory, Department of Histocompatibility and Transplant Immunology, New Delhi, India
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Rao N, Chandra A, Saran S, Singh A, Singh S. COVID-19 infection in kidney transplant recipients during the first versus the second wave - Retrospective Observational study from a single center. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Kute V, Desai S, Meshram H, Shah K, Chauhan S, Mishra V, Sahay M. On the way to mandate booster vaccine dose of coronavirus disease 2019 for transplant recipients: A narrative review of literature. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meshram HS, Kute VB, Swarnalatha G, Hegde U, Sharma A, Sahay M, Guleria S, Raju SB, Eapen JJ, Ray DS, Chaudhury AR, Patel HV, Siddini V, Pathak V, Agarwal D, Bahadur MM, Verma PP, Anandh U, Krishna A, Abraham A, Mishra V. Effect of Coronavirus Disease 2019 on Transplantation and Nephrology in India: A Nationwide Report From India. Transplant Proc 2021; 54:1429-1433. [PMID: 34706823 PMCID: PMC8486646 DOI: 10.1016/j.transproceed.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effect of coronavirus disease 2019 (COVID-19) on a developing nation is sparsely reported and, more importantly, the discrepancies in public and private sectors are underexplored. METHODS We retrospectively investigated the data on the effect of COVID-19 on renal transplantation between 2019 and 2020 in a nationwide analysis from 8 public and 10 private sector hospitals of India. RESULTS On comparing the yearly data, the number of living-related transplants and deceased donor transplants declined by 48% (2610 vs 1370) and 49% (194 vs 99), respectively. The outpatient numbers and in-center admissions decreased by 40.4% (616,741 vs 367,962) and 30.8 % (73,190 vs 49,918). respectively. There was no increase in the number of renal or graft biopsies in the COVID-19 era. The number of waitlisted patients on hemodialysis was higher in public (304,898 vs 338,343) when compared with private (163,096 vs 150,292) in the last 2 years. Similarly, the number of waitlisted patients on peritoneal dialysis (4655 vs 3526) was higher in the public sector compared with private sector (932 vs 745). The decline in living transplants during the pandemic was higher in public sectors (58%) compared with the private (49%). However, the decline in deceased donation was higher in private (57.9%) relative to public (50.6%). CONCLUSIONS COVID-19 has adversely affected the transplantation activities across the Indian transplantation centers, with a disproportionately higher impact on waitlisted patients in public sector programs. A sound prioritization of health care resources is mandated to safeguard the most deprived and high-risk waitlisted patients during the pandemic.
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Affiliation(s)
- Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
| | - G Swarnalatha
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Jeethu Joseph Eapen
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Arpita Ray Chaudhury
- Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | | | - Vivek Pathak
- Department of Nephrology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | | | | | - Prem P Verma
- Department of Nephrology, Venkateshwar Hospital, New Delhi, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Abi Abraham
- Department of Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Vineet Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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