Immune Suppressive Medications Role in the Prognosis of COVID-19 Among Kidney Transplant Recipients

Introduction. Kidney transplant recipients are among the most critical individuals when facing COVID-19 pneumonia with increased risk of morbidities and mortalities. Immune suppressive medications are essential to prevent from rejection, while due to their immuneassociated properties, these drugs are one of the major culprits for severe pneumonia. The current study aims to investigate the role of these agents in prognosis of COVID-19 pneumonia. Methods. The current cross-sectional study was conducted on 139 kidney transplanted recipients hospitalized due to COVID-19 pneumonia. The transplant-related medications including angiotensin convertase enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), corticosteroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian targets of rapamycin inhibitors were recorded and their prognosticating role in the mortality and survival of the patients was evaluated through logistic and cox regression in crude and adjusted models: 1) age and gender, and 2) age, gender, medical diseases and COVID-19 severity. Results. Based on logistic regression assessment, none of the consumed drugs by kidney transplant recipients had a preventive role in the mortality of the patients in either crude or adjusted models (P > .05). However, cox regression measures revealed that treatment with ACEI/ARB was accompanied by longer survival in the crude (HR = 0.532, 95% CI: 0.333 to 0.851, P = .008) and adjusted models 1 (HR = 0.515, 95% CI: 0.318 to 0.833, P = .007) and 2 (HR = 0.583, 95% CI: 0.349 to 0.975, P = .040), respectively. Conclusions. Based on the findings of the current study, ACEI/ ARB use was accompanied with decreased length of ICU stay among the kidney transplant patients with COVID-19 infection, while the other medications did not have any effect.