2125. Covid-19 in Kidney Transplant Recipient and Waitlist Patients: Implications of Chest Radiographic Severity Score
Authors * Denotes Presenting Author
  1. Yuchen Dong; Einstein Medical Center
  2. Anant Dhingra *; Einstein Medical Center
  3. Stephanie Shamir; Montefiore Medical Center
  4. Yorg Al Azzi; Montefiore Medical Center
  5. Stuart Greenstein; Montefiore Medical Center
  6. Linda Haramati; Montefiore Medical Center
To evaluate the chest radiographic severity score (CXR-SS) for COVID-19 patients who are kidney transplant recipients versus those on the kidney transplant waitlist. Our secondary objective was to evaluate the relationship between CXR-SS with clinical variables and outcomes.

Materials and Methods:
This IRB-approved single center retrospective study includes 77 kidney transplant recipients (49 men, mean age 60.2 + 11.7 years) and 60 kidney transplant waitlist patients (34 men, mean age 58.8 + 10.7 years) who were diagnosed with COVID-19. Index CXR at earliest COVID manifestation was reviewed. CXR-SS divided the frontal radiograph into 6 zones and yielded a final score between 0-6. Index and endpoint laboratory values within 2 days of index imaging date or discharge and death, respectively. Outcomes include admission length, intubation event, ICU admission, discharge and death. Bivariate analysis and multivariate regression analysis were performed; p<0.05 was considered significant.

Kidney transplant patients with Covid-19 had a median CXR-SS of 3 (IQR= 1-5) and patients on the kidney transplant waitlist with a median CXR-SS of 2 (IQR= 0-4). No significance was found between the CXR-SS between two groups [p= 0.1313]. 96% (74/77) of kidney transplant patients with COVID-19 were admitted to the hospital as compared to 22% (13/60) on the waitlist, [p=0.01]. Mortality was significantly higher for transplant patients than for those on the waitlist [38% (29/77) vs 3% (2/60), p< 0.001]. Transplant patients were also significantly more likely to be intubated [27% (21/77 vs 3% (2/60), p= 0.005] and admitted to the ICU [27% (20/74) vs 6% (3/47), p= 0.004]. A higher CXR-SS was associated with hospital admission in the waitlist group (p= 0.03) but not in the transplant recipient group. CXR-SS was not associated with length of hospital stay or intubation in either group.

Kidney transplant patients with Covid-19 had near universal hospital admission, more than one-third died and about a quarter were intubated and admitted to the ICU, all significantly worse outcomes than for patients on the transplant waitlist. There was a trend towards higher CXR-SS for transplant patients than for those on the transplant waitlist.