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\begin{document}

\title{Clinical Outcomes of Post Renal Transplant Patients with COVID-19
Infection: A single-center case series}



\author[1]{Shaikh  Maheboob}%
\author[1]{Mohamad  Khatib}%
\author[1]{Mohammad Alwraidat}%
\author[1]{Dore  Ananthegowda}%
\author[1]{Muftah  Abdallah}%
\author[1]{Asra  Aroos}%
\author[1]{Sagar  Jujjavarapu}%
\author[1]{Saptarshi  Banerjee}%
\author[1]{Zishan  Nasir}%
\author[1]{Ahmed soliman Mohamed}%
\author[1]{Moustafa Elshafei}%
\author[1]{Abdulqadir Nashwan}%
\affil[1]{Hamad Medical Corporation}%


\vspace{-1em}



  
  \date{May 04, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Post renal transplant patients are generally immunosuppressed and remain
at a higher risk for getting bacterial and viral infections. Most of
these patients are taking immunosuppressive medications, including
steroids. This case series highlights the clinical outcomes and
characteristics of 8 post renal transplant patients who acquired
COVID-19.%
\end{abstract}%



\sloppy


\textbf{Clinical Outcomes of Post Renal Transplant Patients with
COVID-19 Infection: A single-center case series}

\emph{Short title: Post Renal Transplant and COVID-19}

Shaikh N. Maheboob\textsuperscript{1}, Mohamad Y.
Khatib\textsuperscript{2}, Mohammad A. Al Wraidat\textsuperscript{2},
Dore C. Ananthegowda\textsuperscript{2}, Muftah A.
Abdallah\textsuperscript{3}, Asra Aroos\textsuperscript{2}, Sagar B.
Jujjavarapu\textsuperscript{3}, Saptarshi Banerjee\textsuperscript{2},
Zishan Nasir\textsuperscript{3}, Ahmed S. Mohamed\textsuperscript{2},
Moustafa S. Elshafei \textsuperscript{2}, Abdulqadir J.
Nashwan\textsuperscript{2}

\begin{enumerate}
\tightlist
\item
  Surgical Intensive Care Department, Hamad General Hospital (HGH),
  Hamad Medical Corporation (HMC), Doha, Qatar.
\item
  Medical Intensive Care Department, Hazm Mebaireek General Hospital
  (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar.
\item
  Nephrology Department, Hazm Mebaireek General Hospital (HMGH), Hamad
  Medical Corporation (HMC), Doha, Qatar
\end{enumerate}

Corresponding author:

Mr. Abdulqadir J. Nashwan

anashwan@hamad.qa

Tel: (+974) 40240487

Mob: (+974) 66473549

P.O.Box 3050 Doha, Qatar

\textbf{Abstract}

Post renal transplant patients are generally immunosuppressed and remain
at a higher risk for getting bacterial and viral infections. Most of
these patients are taking immunosuppressive medications, including
steroids. This case series highlights the clinical outcomes and
characteristics of 8 post renal transplant patients who acquired
COVID-19.

Keywords: COVID-19 infection, hypertension, acute kidney injury,
immunosuppression, renal transplant, end-stage renal disease

\textbf{Key Clinical Message:}

There is a paucity of available literature regarding the impact of
COVID-19 infection in post-renal transplant patients. These patients
have a higher chance of acquiring severe COVID-19 infection, more
complications, and poor prognosis.

\textbf{Background}

Coronavirus disease (COVID-19) started in China as a severe pneumonia of
unknown cause in late 2019 and quickly spread throughout the world with
human-to-human transmission. COVID-19 was declared a pandemic in the
first quarter of 2020 by the World Health Organization (WHO) and has
caused a significant loss of human lives and financial resources
worldwide.(1) The pandemic is far from being over and has compromised
even the most developed countries' healthcare systems. There are various
risk factors for getting severe COVID-19 infection, such as patients'
age, co-morbidities such as diabetes, cardiovascular and chronic
respiratory disorders (2-4). However, the role of immunosuppression
therapy is still not clear.(5) Use of the immunosuppressant medication
in post-renal transplant patients may increase the risk of various viral
infections.(6)

Adequate literature is not available from the region regarding the
impact of COVID-19 infection in post-renal transplant patients, whereas
the international literature is limited to a case series with contrast
findings and conclusions.(7)

This case series explores the occurrence of COVID-19 infection in
post-renal transplant patients, their risk factors, severity, course of
the disease, and outcomes.

\textbf{Patient and Methods}

We enrolled all post renal transplant patients diagnosed with COVID-19
infection with a Polymerase chain reaction test (PCR) who were admitted
to the intensive care unit (ICU) of our hospital from
1\textsuperscript{st} March to 30\textsuperscript{th} September 2020.
All patient's demographic data, number and type of comorbidities, type
and timing of the transplant, current patient medications, the severity
of the disease, sepsis markers, acute kidney injury, renal replacement
therapy requirements, secondary infections, ventilatory requirements,
and ventilator days, need of vasopressors and outcomes were recorded
retrospectively from the patients' electronic data files.

\textbf{Results}

A total of 8 post renal transplant patients with COVID-19 were admitted
to our intensive care unit during the study period. Five of the eight
patients were female. The most common comorbid condition among all our
patients was hypertension (all 8 patients). Four of our patients were
type-II diabetic. Another 4 patients had a previous history of
respiratory disease (chronic), including asthma or chronic obstructive
pulmonary disease (COPD), while coronary artery disease and
hyperlipidemia was present in 4 and 1 patient, respectively (Table 1).
Five patients had a history of a renal transplant from living related
donors, while 3 patients had received their kidneys from cadaveric
donors. Post renal transplant period ranged from 4 to 16 years with a
mean of 8.6 years (Table 2). Septic markers, including COVID-19 severity
markers, were significantly elevated (c-reactive protein, ferritin,
d-Dimer, and fibrinogen). Mean APACHE score as 13.88 with a range of
6-20 (Table 2). All patients had been taking immunosuppressant
medications and steroids at the time of infection with the virus.
Secondary bacterial infection occurred in 3 patients, 3 patients
required invasive ventilatory support, and 3 patients received renal
replacement therapy, including hemodialysis, after developing acute
kidney injury (Table 3). Mean mechanical ventilation days in the 3
intubated patients were 20.19 with a range of 14 to 25 days (Table 3).
Four patients required vasopressors to maintain their hemodynamics. One
patient died while staying in the ICU giving a mortality of 12.5\% in
our patient series. (Table 3)

\textbf{Discussion}

Post renal transplant patients are hypothetically at a higher risk of
acquiring COVID-19 infection due to various reasons, including
immunosuppressive medication, steroid therapy, and malnutrition.(6)
Elias et al identified obesity, diabetes mellitus, and chronic pulmonary
diseases as some of the risk factors in post-renal transplant patients
for getting COVID-19 infection.(8) Elhadedy et al. also found that
hypertension and Diabetes mellitus were the most common risk factors for
COVID-19 infection in this group of patients.(9) The most common risk
factors or comorbidity were hypertension, Diabetes mellitus, and chronic
pulmonary disease in our patient population. All our patients had
undergone kidney transplants years back, and most received the kidney
from live-related donors. This contrasted with most of the literature,
which states that cadaveric renal transplants and recently transplanted
renal recipients were at a higher risk of acquiring COVID-19
infection.(8, 9) We also had a higher number of female patients, which
is in contrast to the available literature.(8, 9) Similarities to
literature include having very high inflammatory and sepsis markers,
including ferritin, C reactive protein, fibrinogen, and D Dimers.
Immunosuppressants medications were continued in lower doses, and our
patients also received steroids during their ICU stay. Acute kidney
injury and the requirement of renal replacement therapy is also common
with COVID-19 infection. A study from England reported that 57\% of post
renal transplant patients with COVID-19 required renal replacement
therapy.(10) Elhadedy et al reported that 26\% of their patients
required hemodialysis. Our patient's series 26\% of this group of
patients required renal replacement therapy. 37\% of our patients
required intubation and invasive ventilation. Elias et al reported that
22\% of their patients required invasive ventilation.(8) Banerji et al
reported one (14\%) out of their 7 patients required invasive
ventilation.(10) Available literature describes that post renal
transplant patients with COVID-19 infection had higher mortality than
the general population, ranging from 14 to 24\%.(8, 10) In our case
series, mortality was 12.5\% as one of our eight patients died from
complications of the disease.

\textbf{Conclusion:}

Post renal transplant patients have high chances of complications with
COVID-19 infection due to their immunosuppressed status and related
comorbidities. They also have a significant risk of developing acute
kidney injury and severe pneumonia requiring invasive ventilation. In
our case series, hypertension was a common risk factor, and female
patients were more significant in number. Most of the patients had
received the transplanted kidneys years ago, and all of them were taking
immunosuppressive medications, including steroids. Complications of
disease and mortality among these critical patients were high.

\textbf{Declarations}

\textbf{Ethics approval and consent to participate}

The article describes a case series. Therefore, no additional permission
from our Ethics Committee was required.

\textbf{Consent for publication}

The consent for publication was obtained.

\textbf{Availability of data and material}

All data generated or analyzed during this study are included in this
published article.

\textbf{Competing interests}

The authors declare that they have no competing interests.

\textbf{Funding}

This study was not funded.

\textbf{Authors' contributions}

SNM, MYK, MAW, DCA, MAA, AAO, SBJ, SBE, ZNR, ASM, MSE, AJN: Data
Collection, Literature Search, Manuscript Preparation.

All authors read and approved the final manuscript.

\textbf{Acknowledgments}

Open Access funding provided by the Qatar National Library.

\textbf{References}

1. Organization WH. Coronavirus disease (COVID-19) Weekly
Epidemiological Update and Weekly Operational Update. 2020.

2. Iqbal FM, Soliman, A., De Sanctis, V., Mushtaq, K., Nair, A. P., Al
Masalamani, M., Sasi, S., Ali, E., Hassan, O., Nashwan, A. J., Fahad,
J., Yassin, M. A. Prevalence, Clinical Manifestations, and Biochemical
Data of Hypertensive versus Normotensive Symptomatic Patients with
COVID-19: A Comparative Study. Acta Bio Medica Atenei Parmensis.
2020;91(4):e2020164.

3. Soliman AT, Prabhakaran Nair A, Al Masalamani MS, De Sanctis V, Abu
Khattab MA, Alsaud AE, et al. Prevalence, clinical manifestations, and
biochemical data of type 2 diabetes mellitus versus nondiabetic
symptomatic patients with COVID-19: A comparative study. Acta Bio Medica
Atenei Parmensis. 2020;91(3):e2020010.

4. Khatib MY, Peediyakkal MZ, Elshafei MS, Elzeer HS, Ananthegowda DC,
Shahen MA, et al. Comparison of the clinical outcomes of non-invasive
ventilation by helmet vs facemask in patients with acute respiratory
distress syndrome. Medicine. 2021;100(4).

5. Etienne N, Karmochkine M, Slama L, Pavie J, Batisse D, Usubillaga R,
et al. HIV infection and COVID-19: risk factors for severe disease. AIDS
(London, England). 2020;34(12):1771.

6. Linares L, Cof\selectlanguage{ngerman}án F, Cervera C, Ricart M, Oppenheimer F, Campistol J,
et al., editors. Infection-related mortality in a large cohort of renal
transplant recipients. Transplantation proceedings; 2007: Elsevier.

7. Mahalingasivam V, Craik A, Tomlinson LA, Ge L, Hou L, Wang Q, et al.
A Systematic Review of COVID-19 and Kidney Transplantation. Kidney
International Reports. 2020.

8. Elias M, Pievani D, Randoux C, Louis K, Denis B, Delion A, et al.
COVID-19 infection in kidney transplant recipients: disease incidence
and clinical outcomes. Journal of the American Society of Nephrology.
2020;31(10):2413-23.

9. Elhadedy MA, Marie Y, Halawa A. COVID-19 in Renal Transplant
Recipients: Case Series and a Brief Review of Current Evidence. Nephron.
2020:1-7.

10. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19
infection in kidney transplant recipients. Kidney international.
2020;97(6):1076-82.

\textbf{Table 1: Patients demography and comorbidities}\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
Patient & Gender & Age (Years) & Diabetes mellitus & Hypertension &
Coronary Artery Disease & Chronic Respiratory disease &
Hyperlipidemia\tabularnewline
\midrule
\endhead
1 & Female & 61 & No & No & No & Yes & No\tabularnewline
2 & Female & 35 & No & Yes & No & No & No\tabularnewline
3 & Female & 53 & No & Yes & No & Yes & Yes\tabularnewline
4 & Male & 54 & Yes & Yes & No & No & No\tabularnewline
5 & Male & 63 & Yes & Yes & Yes & No & No\tabularnewline
6 & Female & 61 & YES & YES & NO & YES & NO\tabularnewline
7 & Male & 55 & NO & YES & NO & NO & NO\tabularnewline
8 & Female & 51 & YES & YES & YES & YES & NO\tabularnewline
& 5: Female/3: Male & Mean=54.1 & Yes:4(50\%) & Yes:7(87.5\%) &
Yes:2(25\%) & Yes:4(50\%) & Yes:1(12.5\%)\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table2: Renal transplant detail and markers}\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
\begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
Patient Number\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
Years of transplant\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
Type of renal transplant\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
APACHE2 Score\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
Ferritin levels\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
d-Dimer\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
Fibrinogen\strut
\end{minipage} & \begin{minipage}[b]{0.10\columnwidth}\raggedright\strut
C-reactive protein\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Live related Donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
587\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0.85\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4.8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
165.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Deceased donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
367\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0.81\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3.6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
30\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Live related Donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
693\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.77\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8.2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
287.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Deceased donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1398\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0.55\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4.3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
76.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Deceased donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
25\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
335\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
N\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
295.5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Live related Donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
15\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1010\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0.91\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4.8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
42\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Live related Donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
386.00\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.03\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4.8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
156.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Live related Donor\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1467\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.07\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
104.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Mean=8.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Live related Donor=5 Deceased donor=3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Mean:13.88\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Elevated\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Elevated\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Elevated\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Elevated\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table3: Descriptive and outcome parameters}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Patient Number\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Acute kidney injury (AKI) required RRT\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Secondary infection\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Intubation\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Mechanical Ventilation days\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Total ICU stay (days)\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
Mortality\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
25\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
25\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
64\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
19\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
No\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
YES\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
YES\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NO\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
41\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
NO\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Required RRT: 3(37.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yes:5(62.5\%) No:3(37.5)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yes:3(37.5\%) No:5(62.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Mean:20.19\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Mean:22.75\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Yes:1(12.5\%)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

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