The Mycophenolate-based Immunosuppressive Regimen Is Associated With Increased Mortality in Kidney Transplant Patients With COVID-19.
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Requião-Moura Lúcio R, Modelli de Andrade Luís Gustavo, de Sandes-Freitas Tainá Veras, Cristelli Marina Pontello, Viana Laila Almeida, Nakamura Mônica Rika, Garcia Valter Duro, Manfro Roberto Ceratti, Simão Denise Rodrigues, Almeida Ricardo Augusto Monteiro de Barros, 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, COVID-19-KT Brazil Study Group*
Аннотация
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.