The adverse effects of high-dose corticosteroid on infectious and non-infectious sequelae in renal transplant recipients with coronavirus disease-19 in India.

Abstract

IntroductionThe corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease‐19 (COVID‐19) is not well defined. We aimed to analyze the outcomes and infectious and non‐infectious sequelae in RTR with COVID‐19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID‐19.Materials and methodsThis study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID‐19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non‐infectious sequelae with reference to high‐dose and standard‐dose corticosteroids.ResultsA total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high‐dose steroids was also significantly high in non‐survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID‐19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6‐month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post‐COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high‐dose corticosteroid group than in the standard‐dose group.ConclusionHigh‐dose corticosteroid dosing in RTRs with COVID‐19 was associated with increased infections, particularly fungal infections, and non‐infectious sequelae with higher mortality on subsequent follow‐up.