The Mycophenolate-based Immunosuppressive Regimen Is Associated with Increased Mortality in Kidney Transplant Patients with COVID-19

• Autor(a) principal: Requião-Moura, Lúcio R.
• Data de Publicação: 2022
• Outros Autores: De Andrade, Luís Gustavo Modelli [UNESP], De Sandes-Freitas, Tainá Veras, Cristelli, Marina Pontello, Viana, Laila Almeida, Nakamura, Mônica Rika, Garcia, Valter Duro, Manfro, Roberto Ceratti, Simão, Denise Rodrigues, De Barros Almeida, Ricardo Augusto Monteiro [UNESP], Ferreira, Gustavo Fernandes, Costa, Kellen Micheline Alves Henrique, De Lima, Paula Roberta, Pacheco-Silva, Alvaro, Charpiot, Ida Maria Maximina Fernandes, Deboni, Luciane Mônica, Ferreira, Teresa Cristina Alves, Mazzali, Marilda, Calazans, Carlos Alberto Chalabi, Oriá, Reinaldo Barreto, Tedesco-Silva, Hélio, Medina-Pestana, José, De Oliveira, Claudia Maria Costa, Esmeraldo, Ronaldo De Matos, Baptista, Maria Alice Sperto Ferreira, De Sousa, Marcos Vinícius, De Mello Santana, Viviane Brandão Bandeira, Romão, Elen Almeida, Zanocco, Juliana Aparecida, Bignelli, Alexandre Tortoza, De Boni Monteiro De Carvalho, Deise, De Lourdes Noronha, Irene, Da Rocha Saldanha, Anita Leme, Romao, Joao Egídio, Arimatea, Gustavo Guilherme Queiroz, Lasmar, Marcus Faria, Rioja, Suzimar Da Silveira, Kroth, Leonardo Viliano, Madeira, Rafael Lage, Miorin, Luiz Antônio, Malafronte, Patrícia, Pozzi, Carolina Maria, Pinheiro, Helady Sanders, Maciel, Rafael Fabio, Da Fonte Andrade, Larissa Guedes, Filho, Lauro Monteiro Vasconcellos, De Carvalho Contieri, Fabiana Loss, Neves, Carolina Lara, Pereira, André Barreto, Silva, Amanda Maíra Damasceno, Palma, Lilian Monteiro Pereira, De Souza, Pedro Augusto Macedo, Machado, David José Barros, Saber, Luciana Tanajura Santamaria
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://dx.doi.org/10.1097/TP.0000000000004251; http://hdl.handle.net/11449/246030

Background. The chronic use of immunosuppressive drugs is a key risk factor of death because of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs), although no evident association between the class of immunosuppressive and outcomes has been observed. Thus, we aimed to compare COVID-19-associated outcomes among KTRs receiving 3 different immunosuppressive maintenance regimes. Methods. This study included data from 1833 KTRs with COVID-19 diagnosed between March 20 and April 21 extracted from the national registry before immunization. All patients were taking calcineurin inhibitor associated with mycophenolate acid (MPA, n = 1258), azathioprine (AZA, n = 389), or mammalian targets of rapamycin inhibitors (mTORi, n = 186). Outcomes within 30 and 90 d were assessed. Results. Compared with patients receiving MPA, the 30-d (79.9% versus 87.9% versus 89.2%; P < 0.0001) and 90-d (75% versus 83.5% versus 88.2%; P < 0.0001) unadjusted patient survivals were higher in those receiving AZA or mTORi, respectively. Using adjusted multivariable Cox regression, compared with patients receiving AZA, the use of MPA was associated with a higher risk of death within 30 d (adjusted hazard ratio [aHR], 1.70; 95% confidence interval [CI], 1.21-2.40; P = 0.003), which was not observed in patients using mTORi (aHR, 0.78; 95% CI, 0.45-1.35; P = 0.365). At 90 d, although higher risk of death was confirmed in patients receiving MPA (aHR, 1.46; 95% CI, 1.09-1.98; P = 0.013), a reduced risk was observed in patients receiving mTORi (aHR, 0.59; 95% CI, 0.35-0.97; P = 0.04) compared with AZA. Conclusions. This national cohort data suggest that, in KTRs receiving calcineurin inhibitor and diagnosed with COVID-19, the use of MPA was associated with higher risk of death, whereas mTORi use was associated with lower risk of death.