Abstract
Abstract Background Current knowledge about risk factors for severe COVID-19 among kidney transplant recipients stem from meta-analyses of small or regional studies. Methods All kidney transplant recipients in Sweden as of January 1, 2020 (n = 5 824) were followed during the first two years of the pandemic. Data from the Swedish Renal Registry and linked health care registries were analysed by multivariable adjusted logistic regression to identify risk factors for severe COVID-19, defined as hospitalization or death due to COVID-19. Results Male sex increased the risk of severe COVID-19. While many comorbidities were associated with increased risk, their significance diminished after adjustment for other factors. Kidney transplant recipients of working age, 49–58 years adjusted odds ratio (aOR) 2.32 (95% CI 1.53–3.51) and 59–68 years aOR (1.92; 1.26–2.91) had the highest risk compared to the youngest age group (18–38 years). Compared to recently (<1 year) transplanted patients, those transplanted more than 5 years ago had lower the risk of severe COVID-19 (aOR 0.52; 0.36–0.75 for 6–10 years; aOR 0.57; 0.41–0.79 for > 10 years). Longer pre-transplant dialysis vintage (aOR1-year 1.04; 1.01–1.06) and deceased donor kidneys (aOR 1.41; 1.09–1.84) increased the risk. Immunosuppression with mycophenolate mofetil (aOR 1.47, 95% CI 1.08–1.99) and proton pump inhibitor use (aOR 1.58, 95% CI 1.24–2.01) was strongly associated with severe COVID-19. Conclusions While kidney transplant recipients share risk factors with the general population, working age groups were at the highest risk- unlike in the general population. These findings emphasize the need for targeted prevention and treatment strategies for kidney transplant recipients in future pandemics.
Published Version
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