Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2023; 13(6): 344-356
Published online Dec 18, 2023. doi: 10.5500/wjt.v13.i6.344
Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program
Abbas Ghazanfar, Madiha Abbas, Md Walid Hussain, Malik Kayal
Abbas Ghazanfar, Renal and Transplant Unit, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
Madiha Abbas, Department of Anesthesia and Intensive Care Medicine, Epsom and St Helier University Hospitals NHS Trust, London KT8 7EG, United Kingdom
Md Walid Hussain, Malik Kayal, Department of Renal and Transplant Surgery, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
Author contributions: Ghazanfar A and Abbas M contributed to study design, data analysis, manuscript writing; Ghazanfar A and Hussain Md W contributed to data collection; Kayal M contributed to manuscript writing support.
Institutional review board statement: Compliance with local ethical and data protection policies. Registered with St Georges University Hospitals NHS Foundation Trust Quality Assurance Department. Registration no AUD1000854.
Informed consent statement: Online assessment confirmed that no patient consent or ethical approval from NHS HRA/REC was required.
Conflict-of-interest statement: Authors have no conflict of interest related to the content of this publication.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address a.ghazanfar@nhs.net.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abbas Ghazanfar, MBBS, FACS, FCPS, FEBS, FICS, FRCS, RCPathME, Chairman, Doctor, Researcher, Senior Lecturer, Surgeon, Renal and Transplant Unit, St Georges University Hospitals NHS Foundation Trust, London SW17 0QT, London SW17 0QT, United Kingdom. a.ghazanfar@nhs.net
Received: July 20, 2023
Peer-review started: July 20, 2023
First decision: September 5, 2023
Revised: October 21, 2023
Accepted: November 13, 2023
Article in press: November 13, 2023
Published online: December 18, 2023
Abstract
BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation. In the course of acute SARS-CoV-2 infection, various laboratory markers have been identified as predictors for high risk of mortality.

AIM

To risk stratify renal transplant recipients (RTxR) using general demographic parameters, comorbidities and routine laboratory markers for the severity of the disease and its outcomes. We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.

METHODS

This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021. We recorded the basic demographics, comorbidities and routine laboratory markers. We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.

RESULTS

From 505 RTxRs in our renal transplant follow-up program, 29 (7.75%) RTxRs had PCR-positive SARS-CoV-2 infection. We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6% but a significant 27.6% mortality in SARS-CoV-2 positive recipients. Age more than 68 years, non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability; P ≤ 0.001. < 0.001 and < 0.0001 respectively. 87.5% of the deceased were diabetic; P ≤ 0.0.0001. Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2, serum albumin less than 20 g/L, Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality; P = 0.0128, < 0.001, < 0.0001 and 0.0061 respectively.

CONCLUSION

This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity. This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.

Keywords: SARS-CoV-2 mortality, Renal transplant recipients, Glomerular filtration rate, Anemia, Albumin, Calcium, Reducing morbidity and mortality, Renal transplant follow-up program

Core Tip: In this present study, we aim to risk stratify renal transplant recipients (RTxR) using general demographic parameters, comorbidities and routine laboratory markers for the severity of the disease and its outcomes. We believe that learning about these routinely monitored parameters can help us to plan better strategies for RTxR follow-up program.