Result of the Transplant Patients
Our hospital was accepted as a pandemic hospital after March 11, 2020, following the first case of COVID-19 seen in our country. As of this date, the kidney transplant program was temporarily suspended until March 2021. Ambulatory service for follow-ups of transplant patients was continued. Treatments of patients were arranged and prescribed through the teleconference method as far as possible. Fifty-eight transplant (female: 21/36.2%; Male:37/63.8%) patients with COVID-19 infection were included. The median age was 44.5 years (28.7-55.2). Median time between the time of transplantation and diagnosis of COVID-19 infection was 71 months (25-140). Fifty-four (93.1%) of patients were PCR-confirmed. Laboratory and imaging findings of the other 4 patients were compatible with COVID-19 infection. There were no findings in the 18 (31%) patients in the imaging. The most common CT findings were bilateral ground-glass findings and diffuse opacities. The most common symptom was myalgia and arthralgia (n:37/63.8%).
The most common cause of kidney failure was diabetic nephropathy. The most common accompanying disease was hypertension (39/67.2%). One of our patients was being treated with Eculuzimab due to atypical hemolytic syndrome (AHUS) postoperatively. (Table 3)
The rate of use of the hydroxychloroquine was 12.1%. Most of the patients were treated with favipiravir (50/86.2%) and Low Molecular Weight Hepatin (LMWH). Antibiotics were administered in the 41 (70.7%) patients for profilaxia or due to seconder infecction. Mean time of hospitalization was 10 days (6-14). Ten patients (17.2%) were treated in the intensive care unit. Nine (22.5%) of hospitalized patients died. The median time between the onset of symptoms and admission to the hospital was 3 (2-5) days. And this rate was 2 (2-3) and 5 (4-5.75) days, respectively, for patients followed up in our center and the external centers (p<0.001). In addition, the hospitalization rates of these patients were 60% (n: 24/40) and 89% (n: 16/18), respectively (p: 0.034).
There was no statistically significant difference between the kidney transplant and hemodialysis patients in terms of mortality. Nonetheless, mortality rate was high among the young patients in the transplant group (p:0.001). In addition, first-year cases where immunosuppression was taken most intensively due to the interruption of kidney transplantation in the first year of the pandemic were not included in the study.