Akademik Veri Yönetim Sistemi
17th BANTAO Congress, Antalya, Türkiye, 10 - 13 Kasım 2022, ss.27
Introduction: After the beginning of the Covid-19 pandemia due to initial reports of
high mortality in patients with multiple comorbidities, ESRD and chronic
immunosuppressive kidney transplant patients almost all transplant centers
develop different immunosuppressive protocols according to their experience. In
this study we revealed the outcomes of our alternative immunosuppressive protocols during the different phases of
Covid-19 pandemic.
Method: In the first phase of Covid-19 due to high mortality
risk of dominant variants until December 2021;the protocol was increased dose
prednisolone (20mg/day) and complete cessation of calcineurin and MMF, when the
dominant variant became Omicron in the second phase, prednisolone 20mg/day, 50%
dose reduction of tacrolimus and MMF cessation were applied. The data were
evaluated retrospectively in terms of mortality, biopsy-proven rejection,
allograft loss, and allograft functions.
Results: From the 592 follow-up patients of our center, 132
of them (13.2%) were infected with
Covid-19. In the first phase, Covid-19 infection developed in 108 patients
(mean age 47.07±12.9 years, 54.6% male, 49% one comorbidity, 9.3% three
comorbidities). The mortality rate was 10.2%, Biopsy proven rejection was 3.7%,
need of RRT was 1.9%, and allograft loss
was 0.9%. Allograft functions of the patients were well preserved (64ml/min vs.
67.4ml/min GFR, 312.3±766.2mg/dl vs. 435.74±1302mg/dl proteinuria, p=NS).
In the second phase of Covid-19 infection, 24 patients were
infected (mean age 47±12.98 years, 45.8% male, 46% one comorbidity, 8.3% three
comorbidities). Mortality was detected in only one of these patients (4.2%),
while biopsy-proven rejection and temporary RRT were required in one patient
(4.2%), allograft loss did not occur. Allograft functions of the patients were
well preserved (60ml/min vs. 63.1ml/min GFR, 211.5±366.2mg/dl vs. 116.29±176
mg/dl proteinuria, p=NS)
Conclusion: In the first phase of Covid-19, with aggressive
immunosuppressive reduction, lower mortality was achieved in kidney transplant
patients than generally reported, while no significant problems were experienced
in terms of allograft function and survival. In the second phase, which had a
milder course, severe patient and allograft protection could be achieved with
moderate immunosuppressive dose reduction.