Early experience with COVID-19 in kidney transplantation recipients: update and review

Abstract

Introduction: little is known on the risk factors, clinical presentation, therapeutic protocols, and outcomes of kidney transplantation recipients (KTRs) who become infected by SARS-CoV-2. Purpose: to provide an updated view regarding the early experience obtained from the management of KTRs with COVID-19. Materials and Methods: A narrative review was conducted using PubMed database to identify relevant articles written in English/Spanish, and published through May 15, 2020. Search terms included: "coronavirus", "severe acute respiratory syndrome coronavirus 2", "SARS-CoV-2", "COVID-19", "COVID", "renal transplantation", and "kidney transplantation". Case series were considered eligible, and case reports excluded. Thirty-four articles were included in the review. Results: KTRs should be considered immunocompromised hosts: potential risk for infection, non-negligible comorbidity, and exposure to long-term immunosuppression. Only single center small retrospective experiences are still available regarding KTRs with COVID-19. SARS-CoV-2 symptoms in KTRs are similar to that observed for the general population, being fever and cough the most frequently observed. Mild-to-moderate symptomatic KTRs can be managed in an outpatient setting, while patients exhibiting severe symptoms must be addmited to hospital. More rapid clinical progression, and higher complication and death rates have been observed for hospitalized KTRs, requiring hemodyalisis or ventilatory support. Lymphopenia, elevated serum markers (C-reactive protein, procalcitonin, IL-6, D-dimer), and chest-X-ray findings consistent with pneumonia are linked to worse prognosis. A number of antiviral therapies have been used. However, it is difficult to draw meaningful conclusions regarding their efficacy at this point. Baseline immunosupression regimen should be adjusted in a case-by-case manner. However, it poses a significant challenge.

SARS-CoV-2 Infection in Kidney Transplant Recipients: A Single-Centre Study of 20 Cases from India

“…AKI has been reported in up to 15% of COVID-19 patients in general population [35]. In KTRs with COVID-19, 21-60% of the patients were noticed to have AKI, while 10% of them required RRT [36]. Kute et al also reported high rates of AKI (48•4%) in their patients [13].…”

COVID-19 Infection Clinical Profile, Management, Outcome, and Antibody Response in Kidney Transplant Recipients: A Single Centre Experience

“…The disease-associated cytokine release syndrome leads to multiorgan dysfunction including acute kidney injury (AKI) in these patients [ 13 ]. The laboratory abnormalities including lymphopenia; elevated acute biochemical markers, that is, C-reactive protein; procalcitonin; interleukin-6; D dimer; and radiological findings of ground glassing; pneumonia; and fibrosis are associated with poor prognosis [ 14 ]. The nonmodifiable clinical spectrum associated with poor outcomes includes obesity, pre-existing respiratory disease, hypertension, male gender, age >60 years, hypertension, diabetes mellitus, tobacco smoking, pre-existing cardiac diseases, and the first year after transplantation [ 3 , 5 , 15 ].…”

The Impact of COVID-19 Disease on Urology Practice

“…Lymphopenia, elevated serum markers (C-reactive protein, procalcitonin, IL-6, D-dimer), and chest X-ray findings consistent with pneumonia are linked to a worse prognosis. 72 …”