Dr Daniela Potter1,2,3, Dr Jason Diep1, Ms Colleen Munro1, Dr Noelle Lin1, Dr Ramon Xu1, Dr Jeffrey Wong1, Dr Robert Porritt4, Dr Michael Maley4, Dr Hong Foo4, Professor Angela Makris1,2,3
1Renal Department – South Western Sydney Local Health District, Liverpool, Australia, 2University of New South Wales, Sydney, Australia, 3University of Western Sydney, Sydney, Australia, 4Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, Australia
Aim: To assess incidence and outcomes of COVID-19 among renal transplant recipients in South Western Sydney Local Heath District (SWSLHD).
Background: COVID-19 disproportionately adversely affects the immunocompromised population. Factors predisposing individuals at risk of adverse outcomes are not fully understood.
Methods: A single centre, retrospective cohort study of prevalent renal transplant recipients between 25/7/21 and 1/5/22. Baseline characteristics, COVID-19 vaccination status, COVID-19 diagnosis, and outcomes were determined from the electronic medical record, Australian vaccination register and ANZDATA. In a subpopulation, post-vaccine seroconversion was detected with EUROIMMUN ELISA. Statistical analysis was performed using SPSS v.28.
Results: We identified 444 prevalent transplant recipients (60% male, 50% diabetic, median age 57.6years (Interquartile range (IQR)21.0) and eGFR 56ml/min/1.73m2 (IQR 33.0).
COVID-19 was diagnosed in 32% (n=142) of patients, with a mortality rate of 7% (n=10). 90% (n=399) received at least 1 vaccination, 3% (n=13) of patients were unvaccinated.
Seroconversion after 2 and 3 vaccines was 18.3% and 52.6% respectively. Seroconversion was associated with protection against COVID-19 (aOR 0.21 95%CI:0.05-0.79, p=0.02).
Respiratory disease (OR 6.8, 95%CI:1.8-25.8, p=0.002), smoking exposure (OR 8.3, 95% CI:1.6-41.5, p=0.003), peripheral vascular disease (OR 13.7, 95%CI:2.6-73.5, p<0.001) and older age (64.5 vs 52.7 years, p=0.017) was associated with COVID-19 related mortality. Smoking exposure (aOR 14.9, 95%CI:1.7-132.1, p=0.015) and respiratory disease (aOR 9.8, 95%CI:1.9-50.0, p=0.006) persisted on multi-variable regression analysis. COVID-19 specific therapies were utilised in 77% (n=109) of positive patients, regardless of vaccination status (p=0.89).
Conclusions: COVID-19 is associated with a higher mortality rate in renal transplant recipients compared to the reported rate in the general population. Post-vaccine antibody response is protective. Respiratory disease and prior smoking exposure may be risk factors for COVID-19 related mortality.
Biography:
Dr Daniela Potter is a Nephrologist working at South West Sydney Local Health District. She originally qualified from Imperial College London, before migrating to Australia in 2012, and has worked across several networks in Sydney and New South Wales. Her clinical interests include all General Nephrology and Chronic Kidney Disease, with a focus on patient education and chronic disease prevention. She has an interest in medical education and is currently appointed a Conjoint at the University of New South Wales.