Donor kidney volume dosing is an important determinant of recipient graft outcomes and may predict recipient kidney function in kidney transplantation.
Low-dose, once daily oral fluconazole is effective antifungal prophylaxis after kidney transplantation without significant effects on tacrolimus trough levels or overall exposure.
A novel coronavirus has had global impact on individual health and health care delivery. In this C4 article, contributors discuss various aspects of transplantation including donor and recipient screening, management of infected patients, and prevention of coronavirus disease (COVID). Donor screening with SARS‐CoV‐2 nucleic acid testing (NAT) close to the time of procurement is recommended. Many programs are also screening all potential recipients at the time of admission. The management of COVID has evolved with remdesivir emerging as a new potential option for transplant recipients. Dexamethasone has also shown promise and convalescent plasma is under study. Prevention strategies for transplant candidates and recipients are paramount. Pediatric‐specific issues are also discussed. Strategies for the psychological well‐being of patients and providers are also imperative, in addition to future research priorities for transplantation.
Background
Acceptable posttransplant outcomes were reported in kidney transplant recipients from donors with coronavirus disease-2019 (COVID-19), however, there are no comparative studies with well-matched controls.
Methods
This multicenter, prospective observational study, which included three transplant centers in the US, enrolled 61 kidney recipients from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected deceased donors. Using optimal matching methods, we matched every recipient to three comparators receiving kidneys from SARS-CoV-2-negative deceased donors with otherwise highly similar characteristics within the same transplant centers to compare 6-month eGFR.
Results
Among recipients of SARS-CoV-2-infected donor kidneys, one recipient died with a functional graft within 6 months. Mean 6-month eGFR was not significantly different between SARS-CoV-2-infected and non-infected donor groups (55±21 and 57±25 mL/min/1.73m2; p=0.61). Six-month eGFR in recipients from SARS-CoV-2-infected donors who died from reasons other than COVID-19 was not significantly different from those from SARS-CoV-2-negative donors (58±22 and 56±25 mL/min/1.73m2; p=0.51). However, recipients from donors who died from COVID-19 had significantly lower 6-month eGFR that those from SARS-CoV-2-negative donors (46±17 and 58±27 mL/min/1.73m2; p=0.03). No donor-to-recipient SARS-CoV-2 transmission was observed.
Conclusions
Six-month eGFR was not significantly different between recipients of kidneys from SARS-CoV-2-infected and non-infected donors. However, those receiving kidneys from donors who died from COVID-19 had significantly lower 6-month eGFR. Donor-to-recipient SARS-CoV-2 transmission was not observed.
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