key: cord-0710008-o754plvw
authors: Cristelli, Marina Pontello; Viana, Laila Almeida; Tedesco-Silva, Helio; Medina-Pestana, José
title: COVID-19 Among Kidney Transplant Recipients: A Look Into Latin America
date: 2021-12-24
journal: Transplantation
DOI: 10.1097/tp.0000000000004020
sha: 0d14ffc5b76386d5acf142535dad48c7b1b63126
doc_id: 710008
cord_uid: o754plvw

nan

A recent systematic review on coronavirus disease 2019 in kidney transplant recipients (KTRs), published on July 1, 2021, in the American Journal of Transplantation, reported 74 studies published between March 2020 and January 18, 2021, accounting for 5559 recipients exclusively from countries in Europe (51%), the United States (34%), and Asia or the Pacific (14%) but none from Latin America. This snapshot of the first wave of the pandemic showed a high rate of hospitalization (84%), acute kidney injury (60%), and mortality (24%) from COVID-19. 1 Latin America consists of 20 low-and middle-income countries and is home to >660 million inhabitants. The pandemic affected >45 million people and led to >1.5 million deaths, with the health systems collapsing under the volume of patients, despite strict quarantine policies. Moreover, the economic implications have exacerbated the high levels of inequality. By 2019, Latin America performed an average of 22 kidney transplants per million population with large geographic disparities but 3 countries performing >30 procedures per million population. 2 In 2020, there was a 32% to 64% reduction in the number of procedures, which was significantly worse than the global averages of 19% in developed countries. 3 We sought data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among Latin American KTRs by conducting a search on PubMed Central, Scielo, and Latin American gray literature platforms on October 29, 2021, for articles published in English and Spanish containing information on demographics and clinical outcomes of SARS-CoV-2 infection ( Table 1 ). The available studies portrayed the first wave of the pandemic. The infection mainly affected patients transplanted >5 y ago, with a high prevalence of hypertension. The median age ranged from 39 to 52 y and the frequency of diabetes from 16% to 49%. Hospitalization was reported in >50% and mechanical ventilation and dialysis in one-third of patients. The mortality from COVID-19 ranged from 14.3% to 35.4% when considering the entire spectrum of SARS-CoV-2 infection and from 25.5% to 40.9% in COVID-19 hospitalized KTRs.

Transplantation in Latin America was thus heavily impacted by the first wave of the SARS-CoV-2 pandemic with both greater reductions in transplant activity and worse mortality among transplant patients than seen in developed nations. The infection impacted younger people than seen in the general population and especially in those with longer-term transplants.

In the second half of 2021, commercial supply agreements and high population acceptance have provided increasing vaccination coverage of the general population, which has already produced substantial reductions in infection indices; however, current vaccination rates are still lower than in Western European countries, which, combined with rising unemployment/informal employment and weak social protection coverage, builds a scenario of vulnerability to new waves of contagion.

Transplant patients remain at substantial risk in Latin America with most piloted effective treatment options potentially unaffordable and with clear evidence of low vaccine immunogenicity among transplant recipients 10-13 ; therefore, 3 or 4 vaccine doses per patient will be critically important, as will ring vaccination of all close contacts of KTRs and continued use of social public health measures to reduce virus circulation, to protect these vulnerable individuals. Included patients diagnosed by RT-PCR (91%), serology, or imaging (9%).

A systematic review and meta-analysis of COVID-19 in kidney transplant recipients: lessons to be learned

Registro Latinoamericano de Diálisis y Trasplante Renal

COVID-19 pandemic and worldwide organ transplantation: a population-based study

COVID-19 in renal transplant patients, on the waiting list and under evaluation for transplantation

COVID-19-KT Brazil. High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: results from the Brazilian multicenter cohort study

COVID-19 among kidney-transplant recipients requiring hospitalization: preliminary data and outcomes from a single-center in Brazil

COVID-19 infection in Chilean renal transplanted patients: incidence and clinical outcomes. Collaborative multicentric study

SARS-CoV2/COVID-19 infection in transplant recipients and in patients on the organ transplant waiting list in Colombia

Survival of transplanted patients infected with moderate and severe COVID-19 in Mexico

A programmatic response, including bamlanivimab or casirivimab-imdevimab administration, reduces hospitalization and death in COVID-19 positive abdominal transplant recipients

Two doses of sars-cov-2 vaccines reduce risk of death due to covid-19 in solid organ transplant recipients: preliminary outcomes from a UK registry linkage analysis

Cellular and humoral immune responses after 3 doses of BNT162b2 mRNA SARS-CoV-2 vaccine in kidney transplant

Antibody response to a fourth dose of a SARS-COV-2 vaccine in solid organ transplant recipients: a case series