Mortality comparison between the COVID-19 Omicron variant and influenza among kidney transplant recipients: a nationwide population-based retrospective cohort study

 

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https://storage.unitedwebnetwork.com/files/1099/bfc2fe7d7cc854ab0c3062b0c1d420c3.pdf
Mortality comparison between the COVID-19 Omicron variant and influenza among kidney transplant recipients: a nationwide population-based retrospective cohort study

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Tomoyuki
Fujikura
Tomoyuki Fujikura tfuji@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Shizuoka Japan *
Koichi Miyashita miya501@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 2 Shizuoka Japan -
Hironao Hozumi hozumi@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 2 Shizuoka Japan -
Yuri Ishino 41245287@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Shizuoka Japan -
Taro Aoki aoki88@hama-med.ac.jp Hamamatsu University School of Medicine Blood Purification Unit Shizuoka Japan -
Naoko Katahasi kths@hama-med.ac.jp Hamamatsu University School of Medicine Postgraduate Clinical Education Center Shizuoka Japan -
Naoko Tsuji ntsuji@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Shizuoka Japan -
Sayaka Ishigaki ishigaki@hama-med.ac.jp Hamamatsu University School of Medicine Blood Purification Unit Shizuoka Japan -
Takamasa Iwakura tkms0421@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Shizuoka Japan -
Shinsuke Isobe isobe58@hama-med.ac.jp Hamamatsu University School of Medicine Blood Purification Unit Shizuoka Japan -
Naro Ohashi ohashi-n@hama-med.ac.jp Hamamatsu University School of Medicine Postgraduate Clinical Education Center Shizuoka Japan -
Takafumi Suda suda@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 2 Shizuoka Japan -
Hideo Yasuda ysdh@hama-med.ac.jp Hamamatsu University School of Medicine Internal Medicine 1 Shizuoka Japan -
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Although the SARS-CoV-2 Omicron variant demonstrates lower mortality than previous variants in the general population, its mortality risk in immunocompromised kidney transplant recipients (KTRs)remains concerning. The present study compared Omicron-related mortality with that of seasonal influenza in KTRs.

Using the National Database of Health Insurance Claims of Japan, we conducted a retrospective cohort study of KTRs diagnosed with COVID-19 during the Omicron period (January 2022-March 2023) or influenza (September 2017-March 2023). The primary outcome was 30-day all-cause mortality. Inverse probability of treatment weighting (IPTW) based on propensity scores was employed to adjust for confounding factors. Subgroup analyses were performed stratified by age groups (20–49, 50–59, 60–69, and ≥70 years).

We identified 6,488 COVID-19 and 5,347 influenza cases. After IPTW, the 30-day mortality rates were 1.2% for COVID-19 and 0.2% for influenza (hazard ratio [HR] 4.07 [95% CI 2.18, 7.59]). In subgroup analyses stratified by age, adjusted HRs were as follows: 20–49 years, not estimable due to sparse events; 50–59 years, 2.06 (0.57, 7.48); 60–69 years, 6.52 (1.89, 22.48); and ≥70 years, 3.93 (1.62, 9.54). The adjusted absolute risk differences (excess deaths per 1,000 patients) were 0.1, 3.4, 17.3, and 35.0, respectively.

In this nationwide study, COVID-19 Omicron variant was associated with significantly higher mortality than influenza in KTRs. Age-stratified analyses demonstrated significantly elevated mortality in patients aged ≥60 years; however, further investigation is warranted in younger age groups given the limited number of events.

Kewords