SARS-CoV-2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID-19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID-19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti-COVID-19 treatment in the second wave (July-December) than in the first one (March-June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post-KT should be considered when selecting recipients for transplantation in the COVID-19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.

Jose Portoles, MJ Perez-Saez, Domingo Hernandez, J Espi, D Navarro, J Juega, MA Mazuecos, N Maruri-Kareaga, F Moreso, E Melilli, E de Sousa, JC Ruiz, F Llamas, L Guirado, A Gutierrez, P Martin Moreno, I Perez-Flores, ML Serrano Salazar, C Jimenez, E Gavela, Ana Ramos, J Pascual, RedinRen16/009/009 RETYC ISCIII, Spanish Multicentre Group GEODAS-III Nephrology, H.U.Puerta de Hierro, Madrid, Spain, Nephrology, HU del Mar, Barcelona, Spain and Nephrology, Spanish Multicentre Group GEODAS-III, Madrid, Spain

The aim was to evaluate the relationship between maintenance immunosuppression, subclinical tubulo-interstitial inflammation and interstitial fibrosis/tubular atrophy (IF/TA) in surveillance biopsies performed in low immunological risk renal transplants at two transplant centers. The Barcelona cohort consisted of 109 early and 66 late biopsies in patients receiving high tacrolimus (TAC-C-0 target at 1-year 6-10ng/ml) and reduced MMF dose (500mg bid at 1-year). The Oslo cohort consisted of 262 early and 237 late biopsies performed in patients treated with low TAC-C-0 (target 3-7ng/ml) and standard MMF dose (750mg bid). Subclinical inflammation, adjusted for confounders, was associated with low TAC-C-0 in the early (OR: 0.75, 95% CI: 0.61-0.92; P=0.006) and late biopsies (OR: 0.69, 95% CI: 0.50-0.95; P=0.023) from Barcelona. In the Oslo cohort, it was associated with low MMF in early biopsies (OR: 0.90, 95% CI: 0.83-0.98; P=0.0101) and with low TAC-C-0 in late biopsies (OR: 0.77, 95% CI: 0.61-0.97; P=0.0286). MMF dose was significantly reduced in Oslo between early and late biopsies. IF/TA was not associated with TAC-C-0 or MMF dose in the multivariate analysis. Our data suggest that in TAC- and MMF-based regimens, TAC-C-0 levels are associated with subclinical inflammation in patients receiving reduced MMF dose.

Introduction: Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment.Material and methods: The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data.Results: The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation "not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post-transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment.Conclusions: Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up. (C) 2016 SECA. Published by Elsevier Espana, S.L.U. All rights reserved.