Introduction Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection has drastically impacted the transplant communities. Remdesivir (RDV) has shown some promising results in coronavirus disease (COVID‐19) albeit with low certainty. Data in kidney transplant recipients (KTR) are still lacking. Methods This was a retrospective cohort of 57 moderate to severe COVID‐19 positive KTR in a single center who received RDV as a part of COVID‐19 management. No dose adjustments were done. The outcomes were measured as acute kidney injury (AKI) recovery; liver function tests abnormalities; other side effects; graft loss and death. Results The median (inter‐quartile range) age of presentation was 44 (31‐51) years. The duration from onset of symptoms to RDV initiation was 6 (5‐7) days. Thirty‐two (56%) cases received RDV on the day of admission. Forty‐six (81%) cases were on oxygen support upon initiation of RDV. Thirty‐eight (66.6%) cases had acute kidney injury on admission. The median baseline, admission, and 28‐day follow‐up serum creatinine of the cohort were 1.59 (1.1‐2.1), 2.13 (1.3‐3.1), and 1.58 (1.05‐2.1) mg/dl, respectively. A total of 8(14%) cases died in the study with 1 (1.7%) graft loss. All those cases that died were on oxygen therapy at the time of initiation of RDV. No liver function derangements or any other major adverse events with the drug were reported. Conclusion RDV therapy is safe and clinically feasible in renal transplant recipients as seen in our cohort. Larger clinical registries and randomized clinical trials should be conducted to further explore the efficacy in transplant recipients.

Background There is a scarcity of data comparing the consequences of first and second COVID‐19 waves on kidney transplant recipients (KTRs) in India. Methods We conducted a single‐centre retrospective study of 259 KTRs with COVID‐19 to compare first wave (March 15–December 31 2020, n = 157) and second wave (April 1–May 31 2021, n = 102). Results KTRs during second wave were younger (43 vs. 40 years; p ‐value .04) and also included paediatric patients (0 vs. 5.9%; p ‐value .003). Symptoms were milder during the second wave (45 vs. 62.7%; p ‐value .007); COVID‐19 positive patients had less frequent cough (32 vs. 13.8%; p ‐value .001), fever was less frequent (58 vs. 37%; p ‐value .001), and we observed fewer co‐morbidities (11 vs. 20.6%; p ‐value .04). The percentages of neutrophils (77 vs. 83%; p ‐value .001) and serum ferritin (439 vs. 688; p ‐value .0006) were higher during second wave, while lymphocyte counts were reduced (20 vs. 14%; p ‐value .0001). Hydroxychloroquine (11 vs. 0%; p ‐value .0001) and tocilizumab (7 vs. 0%; p ‐value .004) were more frequently prescribed during first wave, while utilization of dexamethasone (6 vs. 27%; p ‐value .0001) and remdesivir (47 vs. 65%; p ‐value .03) increased during the second wave. Mucormycosis (1.3 vs. 10%; p ‐value .01) and ICU admissions (20 vs. 37.2%; p ‐value .002) were more frequent during second wave. The 28‐day mortality rate (9.6 vs. 10%; p ‐value 1) was not different. Conclusions There has been a different clinical spectrum of COVID‐19 amongst KTR with similar mortality between the two waves at a large Indian transplant centre.

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