Evaluation of demographic, clinical, laboratory, imaging findings and prognosis in the applications of patients with history of renal transplantation in the pandemic

During the pandemic caused by COVID-19, a large number of people experienced health problems and this disease was of greater importance in some high-risk populations. In our study, we aimed to show the demographic, clinical, laboratory and imaging characteristics of patients with a history of kidney transplantation in the COVID-19 pandemic, and to determine the factors affecting the prognosis of the disease in organ transplant recipients who have a high risk of morbidity and mortality in terms of COVID-19 due to the immunosuppressive treatments they receive. In our hospital-based, single-center, retrospective and cross-sectional study; 56 patients with a history of renal transplantation, retrospectively, with possible COVID-19 related complaints, between March 1, 2020 and May 31, 2021, admitted to Başkent University Ankara Hospital Adult Emergency Service, General Surgery Transplantation Outpatient Clinic or COVID-19 Pandemic Outpatient Clinic were included. Demographic information of the patients included in the study, vital and clinical findings at the time of admission, results of laboratory values, COVID-19 PCR sample results, if any, thorax CT results, hospitalization information, treatments applied, and mortality results were recorded. The 'SPSS v25.0 package program' was used in the statistical evaluation. In our study; 78.6% of the patients were men and 21.4% were women. The mean age of the patients was 47.80±12.90 years. The most common complaints of the patients were fever (48.2%) and fatigue/weakness (32.1%); while admission complaints were found to be associated with hospitalization and discharge (p=0.014). HT was found in 44.2%, DM in 17.4%, and CAD in 17.4% of the patients. In 50% (n=28) of the patients, PCR was positive. Respiration rate, saturation and pulse values, which are vital signs at the time of admission, were found to be statistically significant in patients with PCR positive (p<0.05). Hs-Troponin I and glucose values were significantly lower in PCR positive patients (p=0.001; p=0.001; p=0.032; p=0.032, respectively). Potassium and direct bilirubin elevation in PCR positive patients is associated with hospitalization; high AST was associated with admission to the intensive care unit (p=0.046; p=0.046; p=0.031, respectively). While 32.1% (n=18) of the patients who underwent thoracic CT imaging at the first admission had typical findings, 10.7% (n=6) had vague findings, 7.1% (n=4) had atypical findings. Thoracic CT was not performed in 30.4% (n=17) of the patients. While typical findings were observed in 50% (n=14) of patients (n=28) with positive PCR in thorax CT scans (p=0.016), in the other patient group (n=28), 4 patients (14.3%) had typical findings on thorax CT. As a result of the examination and follow-up after hospital admission of the patients with positive PCR, 42.9% (n=12) were sent home, 35.7% (n=10) were hospitalized (13±11), 21.4% (n=6) were admitted to the intensive care unit (13±9). During hospitalization, 28.6% (n=16) of all patients in the sample group received O2 support, 12.5% (n=7) NIMV support, 21.4% (n=12) HFNO support, and % 16.1 (n=9) received MV support. When the whole universe is evaluated; while 78.6% (n=44) of the patients were cured, 21.4% (n=12) died, and the CALL score results were higher and significant with a mean of 8.7±2.17 in the patients who died (p=0.027). It is important to determine the general characteristics of COVID-19 and the factors affecting the prognosis of the disease in patients with a history of renal transplantation, in this special patient population receiving immunosuppressive therapy. Young age group (18-44); male gender; comorbidities of HT, DM, CAD and HL; presence of fever, fatigue/weakness and shortness of breath; low respiratory rate and heart rate and low saturation; low leukocytes, neutrophils, Hs-Troponin I, high potassium with glucose, direct bilirubin and AST values; presence of typical findings on thorax CT was associated with PCR positivity in renal transplantation patients. Therefore, our study; we think that patients in this special population can guide all clinicians, especially Emergency Medicine specialists, in order to be more effective and predict the process in the pandemic. Keywords: COVID-19 pandemic, kidney transplanted patient, Emergency Medicine, prognosis, mortality