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To assess the dynamics of the COVID-19 pandemic among patients after kidney transplantation, a study was conducted with the intention of providing a more detailed understanding of the situation. The study assessed the clinical characteristics, immunosuppression protocol, and outcomes of kidney transplant recipients (KTx) with COVID-19 over five consecutive periods of the disease.
We reviewed all available data (demographics, medical history, immunosuppression protocol, and outcome) on our KTx with COVID-19 during the five consecutive periods of pandemic in Republic of Belarus: the first wave (March-September 2020, n = 71), the second (October 2020-February 2021, n = 170), the third (April –September 2021, n=145), the fourth wave (December 2021 – April 2022) and COVID-19 decline period (May 2022 – April 2023). COVID-19 infection was defined as a positive result for SARS-CoV-2 RNA on real-time polymerase chain reaction assay (PCR) of a nasopharyngeal swab. The severity of the disease was defined on basis of chest CT findings on hospital admission. Chi‑squared test, One‑way ANOVA, and Logistic Regression analysis were applied for statistics analysis.
A study was conducted on 1157 adult kidney transplant recipients who were in active follow-up. Out of these recipients, 449 patients (prevalence of 17.5%) have had COVID-19 over a 36-month period. There were no significant differences observed in age, gender distribution, arterial hypertension, diabetes mellitus as a cause of end-stage renal disease, or baseline immunosuppression among the different epidemiological periods of COVID-19 infection.
Table. Distribution of COVID-19 severity and outcome in kidney transplant recipients during four consecutive waves of the disease
The severity of COVID-19 infection was found to be more frequent during the second and third waves. The table presents the dynamics of disease severity and lethal outcomes during the four waves. It was noted that the lowest rate of severe infection and death occurred during the fourth wave. Contrary to the previous four pandemic waves, the fifth period was characterized by an absence of reported new confirmed COVID-19 deaths and a milder course of infection. These distinct features made it significantly different from the previous waves (p=0.0001).
Results from a multivariate logistic regression analysis identified increasing age (p=0.05) and poor allograft function (p=0.008) as significant predictors of mortality during the four pandemic waves.
In April of 2021, specific vaccination began for transplanted patients. The most widely available vaccines in Belarus were CoronaVac (Sinovac Life Sciences, Beijing, China) and Gam-COVID-Vac (Gamaleya Research Institute of Epidemiology and Microbiology, Russia). The maximum number of fully vaccinated patients reached 239 (20.7%) by February of 2022. However, the vaccination rate declined to 18% by April of 2023, but there remained a high concern for the return of COVID-19 infection. This concern was evident in the total PCR screening of all new patients admitted for transplantation or kidney transplant recipients with clinical symptoms of infection. There was governmental immunization program for all immunocompromised patients that proposed third booster dose.
The results of the study revealed a change in disease severity, with a shift towards milder forms, and the number of COVID-19 deaths reached zero by the end of the follow-up period.