A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India

Table 7

Comparison of present work with similar studies conducted in KTRs infected with COVID-19 during the first and second epidemic waves.

Study Title⟶	Present work Jasuja et al.	Kute et al. [25]	Georgery et al. [47]	Elec et al. [21]	Villanego et al. [45]
Study characteristics
Country	India	India	Belgium	East europe (Romania)	Spanish registry
Study design	Single-center	Single-center	Single-center	Single-center	Multicenter
Study period	1^st wave: 1^st February 2020–31^st January 2021	1^st wave: 15^th March–31^st December 2020	Not mentioned	1^st wave: March–September 2020	1^st wave: January-June 2020
	2^nd wave: 1^st March-31^st August 2021	2nd wave: 1^st April– 31^st May 2021.		2nd wave: October 2020–February 2021	2nd wave: July–December 2020
Number of subjects	1^st wave: 72	1^st wave: 157	1^st wave: 18	1^st wave: 33	1^st wave: 548
	2^nd wave: 84	2^nd wave: 102	2^nd wave: 27	2^nd wave: 149	2^nd wave: 463
Demographics
Age	Comparable	More younger patients in 2^nd wave (study included pediatric population)	Comparable	Comparable	More younger patients 2^nd wave
Height	Comparable	Comparable	Comparable	Comparable	Comparable
Weight	Comparable	Comparable	Comparable	Comparable	Comparable
BMI	Comparable	Comparable	Comparable	Comparable	Comparable
Gender	Male predominance in both waves; comparable		Male predominance in the second wave	Male predominance observed in both waves	Male predominance observed in both waves; comparable
Comorbidities	Comparable between waves	More patients without comorbidities in the second wave	Patients from the second wave had more hypertension and multiple comorbidities	Comparable between waves	—
		More CMV coinfection and hypertension during 2^nd wave
Time interval from transplantation to COVID-19 diagnosis	Comparable	Comparable	Comparable	Comparable	Comparable
Baseline immunosuppression drugs
Steroids	Comparable	Comparable	—	Comparable	Comparable
CNI (Tac/CyA)	Comparable	More in the 1^st wave	—	Comparable	—
MMF/MPA	Comparable	More in the 1^st wave	—	Comparable	—
Immunosuppressants modification during active COVID-19 disease
Antinucleoside/Antimetabolite drugs use	Stopped or reduced in most patients during both waves, comparable	Significantly stopped or tapered during the second wave	Stopped in both waves in all patients	Comparable	—
		(24.5% did not need any immunosuppressant modification during 2^nd wave)
Steroids	In both waves, basal oral prednisolone was stepped up to 20 mg per day (any further modification was based on the patients' condition and appropriate recommendations)	Intravenous methylprednisolone is used in both waves more than in the first. Dexamethasone was the choice in the 2^nd wave	Increased use in 2^nd wave	Steroids were either kept at the maintenance dose or converted to IV for stress dosing in both waves	Increased use in the 2^nd wave
CNI	Altered (reduced or withheld) for more patients during the first wave	Not changed in most patients; comparable between waves	CNI reduced in all patients in both waves	Altered (reduced or withheld) for more patients during the first wave	—
Striking symptoms difference observed between waves
COVID-19 basic symptoms	Symptoms including sore throat, body aches, loss of smell, distaste, loose motions, and running nose were reported significantly more frequently during the second wave	Milder symptoms such as cough were more frequent, while fever and expectoration were less reported symptoms during the second wave	Comparable symptoms	Disease severity was similar between the 2 waves	More patients were asymptomatic in the 2^nd wave
				More patients with COVID-19 pneumonia in the first wave	Fever, cough, lymphopenia, and incidence of pneumonia were less in the 2^nd wave
Mucormycosis	More cases during the second wave	More cases during the second wave	No mention	No mention	No mention
Allograft dysfunction	Comparable	More frequent in the second wave	—	—	—
AKI with or without dialysis requirement	Comparable	Higher in the second wave	—	—	—
COVID-19 supportive/empirical management
Hospitalization	Less frequent during the second wave	Less frequent during the second wave	All patients were hospitalized	Less hospitalization during the second wave	Less hospitalization during the second wave
Doxycycline	Prescribed to more patients in the second wave	Less during the second wave	—	—	—
Tocilizumab	Prescribed to fewer patients in the second wave	Frequently used in the second wave	—	Comparable	Fewer patients in the 2^nd wave
Ivermectin	Prescribed to more patients in the second wave	Not used in the second wave (lack of evidence)	—	—	—
Remedisivir	Prescribed to fewer patients in the second wave	Frequently used in the second wave	—	Slightly more use in the 2^nd wave	More patients in the 2^nd wave
Azithromycin	Comparable	More frequent in the second wave		-	Less in the 2^nd wave
HCQS	Prescribed to fewer patients in the second wave	Frequently used in the second wave	None prescribed in the second wave	Minimal use in the second wave	Almost none (only one patient) prescribed in the 2^nd wave
Convalescent plasma	Prescribed to fewer patients in the second wave	Not used in the second wave (lack of evidence)	—	—	—
Favipiravir/fluvoxin/Ninitedanib	Prescribed to more patients in the second wave	Not used in the second wave (lack of evidence)	—	Slightly more use in the 2^nd wave	More use in the 2^nd wave
Antibiotics/antifungals	Prescribed to fewer patients in the second wave (antifungal use for mucor was more in the second wave)	Not used in the second wave (lack of evidence)	—	—	—
Thromboprophylaxis treatment	Prescribed to fewer patients in the second wave	Frequently used in the second wave	—	Less use in the 2^nd wave	-
ICU admission	Comparable	More during the second wave	Higher in the second wave	Comparable	Comparable
Ventilator	Comparable	Lesser patients in the second wave	—	Comparable	Slightly less during 2^nd wave (18% Vs 11%); statistically comparable
Oxygen requirement	Comparable	Lesser patients in the second wave	—	Comparable	—
CT scan	(i) Higher number of patients in the second wave	—	—	—	—
	(ii) More patients with severe CT scan scores in the second wave
Outcome and follow-up duration
Patient mortality rate	Overall patient mortality rate observed was 27.5%	1^st wave: 9.6%	1^st wave: 18.1%	1^st wave: 24.2%	1^st wave: 27.4%
		2^nd wave: 20%; comparable	2^nd wave: 27.2%; comparable	2^nd wave: 15.4%;	2^nd wave: 15.1%;
Follow-up timeline	1^st wave: 90 days	1^st wave: 28 days	1^st wave: 18 (5–30)	1^st wave: 60 days	—
	2^nd wave: 90 days	2^nd wave: 28 days	2^nd wave: 21 (6–40)	2^nd wave: 90 days

BMI: Body Mass Index; CNI: calcineurin inhibitors; MMF: Mycophenolate Mofetil; Tac: Tacrolimus; CyA: cyclosporine A; HCQS: Hydroxychloroquine Sulfate; AKI: Acute Kidney Injury.