Immune Suppressive Medications Role in the Prognosis of COVID-19 Among Kidney Transplant Recipients

Abstract

 Introduction. Kidney transplant recipients are among the most critical 
individuals when facing COVID-19 pneumonia with increased risk 
of morbidities and mortalities. Immune suppressive medications 
are essential to prevent from rejection, while due to their immune
associated properties, these drugs are one of the major culprits for 
severe pneumonia. The current study aims to investigate the role 
of these agents in prognosis of COVID-19 pneumonia.
 Methods. The current cross-sectional study was conducted on 
139 kidney transplanted recipients hospitalized due to COVID-19 
pneumonia. The transplant-related medications including angiotensin 
convertase enzyme inhibitors (ACEI) or angiotensin receptor blockers 
(ARBs), corticosteroids, calcineurin inhibitors, mycophenolate 
mofetil, and mammalian targets of rapamycin inhibitors were 
recorded and their prognosticating role in the mortality and 
survival of the patients was evaluated through logistic and cox 
regression in crude and adjusted models: 1) age and gender, and 
2) age, gender, medical diseases and COVID-19 severity. 
Results. Based on logistic regression assessment, none of the 
consumed drugs by kidney transplant recipients had a preventive 
role in the mortality of the patients in either crude or adjusted 
models (P > .05). However, cox regression measures revealed that 
treatment with ACEI/ARB was accompanied by longer survival 
in the crude (HR = 0.532, 95% CI: 0.333 to 0.851, P = .008) and 
adjusted models 1 (HR = 0.515, 95% CI: 0.318 to 0.833, P = .007) 
and 2 (HR = 0.583, 95% CI: 0.349 to 0.975, P = .040), respectively. 
Conclusions. Based on the findings of the current study, ACEI/ 
ARB use was accompanied with decreased length of ICU stay 
among the kidney transplant patients with COVID-19 infection, 
while the other medications did not have any effect.