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During the Coronavirus Pandemic, the world experienced a huge medical and socioeconomic impact, with the need for social isolation to reduce the spread of the virus.
Knowing that patients with chronic kidney disease are more susceptible to severe forms of the disease, it was necessary, initially, to reduce the number of face-to-face consultations in addition to reducing and managing immunosuppression in patients suspected of having any infection.
The objective of this study was to analyze the profile of patients undergoing renal biopsy from January 2019 to December 2022, whether there was an increase in the number of renal graft rejections, both cellular and humoral, during and after the period of pandemic and analysis of related outcomes.
All kidney biopsies performed on patients undergoing outpatient follow-up at a transplant institution in Joinville-SC from January 2019 to December 2022 were evaluated. The data analyzed were extracted from the patients' electronic medical records by doctors at the institution. We included demographic variables (gender, age, time since transplantation and number of appointments in the 12 months prior to the biopsy), creatinine at the time of the biopsy, reasons for the indication and results of the biopsy, treatment performed and outcome after treatment. To compare the periods, the results of biopsies from 2019 and 2020 (called pre-pandemic period) and 2021 with 2022 (post-pandemic period) were grouped. To analyze the variables, we used the SPSS software and considered a statistical difference at P<0.05.
Analyzing the 130 patients who underwent renal biopsy, 58.5% were male; the average age found was 44.05 ±13.95 years; the median transplant time in the month of biopsy was 72.5 (38 – 120) months. Regarding the reasons for indicating renal biopsy, 41.5% of patients had proteinuria, 47.7% had an increase in the reactive panel of antibodies, 56.2% had an increase in creatinine, 36.2% had the presence of anti-donor antibodies. The mean creatinine at the time of biopsy indication was 1.6 mg/dL (1.2-2.5) ranging from 0.6 to 9.3 mg/dL. The biopsies results found were 30% cellular rejection, 23.1% humoral rejection, 39.2% chronic changes in the graft. 53.8% of patients underwent immunosuppression adjustment, 25.4% of them underwent pulse therapy with corticosteroids and 19.2% underwent plasmapheresis. Regarding the outcome, 30% of patients showed improvement in renal function, 65.4% of them had creatinine stabilization, 9.2% lost the graft. When comparing biopsy results in relation to the period, there was no statistically significant difference between the pre- and post-pandemic periods, considering rejections (50.9% versus 53.4%, p= 0.455). There was also no difference in the median number of outpatient appointments for these patients throughout the period.When analyzing only patients diagnosed with cellular rejection, there was a significant association between sex and the number of cellular rejections, being more frequent in men than in women (65.9% versus 41%, p=0.007).
Observing the data, we concluded that the restrictions during Coronavirus pandemic did not have a negative impact on the outpatient follow-up of transplant patients in our service, with no reduction in the average number of consultations for those needing in-person consultation, and no increase in the number of rejections to the graft.