Background: COVID-19, identified in 2019, has significantly impacted healthcare, especially transplant medicine. This study examines COVID-19 in kidney transplant patients, focusing on risk factors of moderate or severe outcomes. Methods: A retrospective analysis was conducted on 43 kidney transplant recipients who contracted COVID-19 between April 2020 and October 2023. Patients were classified into mild (N=29), moderate (N=6), and severe (N=8) groups based on the COVID- 19 treatment guidelines. Clinical characteristics, immunosuppressive regimens, metabolic factors, vaccination status, and disease outcomes were analyzed. Univariate and multivariate logistic regression were performed to identify risk factors of moderate or severe COVID-19. Results: The overall mortality rate was 4%, with a 25% mortality rate in severe cases. In univariate analysis, obesity (OR: 4.69, p=0.04) and diabetes mellitus (OR: 6.25, p=0.01) were significantly associated with an increased risk of moderate or severe COVID-19. In multivariate analysis, while statistical significance was not reached, obesity (OR: 8.50, p=0.08), diabetes mellitus (OR: 5.35, p=0.07), and mTOR inhibitor use (OR: 8.60, p=0.06) showed trends toward an increased risk. Age ≥65 years was not significantly associated with severe COVID-19 (OR: 8.42, p=0.18). Conversely, receiving ≥3 doses of COVID-19 vaccination was significantly associated with a reduced risk of moderate or severe disease (OR: 0.07, p=0.03), highlighting the protective effect of booster vaccinations. Conclusion: Diabetes mellitus, obesity, and mTOR inhibitor use may contribute to severe COVID-19 in kidney transplant recipients, necessitating proactive monitoring and immunosuppressive management. Booster vaccinations play a crucial role in reducing disease severity in this high-risk population. Early intervention strategies, including optimizing metabolic control and immunosuppressive therapy, should be prioritized to improve patient outcomes. Further large-scale studies are warranted to confirm these findings.
Kikuchi et al. (Sun,) studied this question.