A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19

Abstract

Background. There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. Methods. We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. Results. Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. Conclusions. Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.

Post-acute COVID-19 syndrome and kidney diseases: what do we know?

“…Rates of symptoms and laboratory abnormalities associated with the post-acute COVID-19 syndrome were statistically significantly higher in kidney transplant patients [ 51 , 52 ]. Despite such findings, high rates of graft survival were reported in relatively large scale studies during the post-acute COVID-19 period [ 53 ]. However, some of the major limitations of these studies were the short follow-up period, the lack of biopsy-proven histopathological changes, and the lack of a clear cause-effect relationship.…”

Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature

“…The median waiting time from COVID-19 diagnosis until transplant was approximately 60 days in this report. A notable aspect of this cohort was that none of the patients had required mechanical ventilation during COVID-19 [ 14 ••]. However, the reported post-transplant follow-up was short, limiting assessment of long-term data.…”

“…after COVID-19 • 2 mos. after COVID-19 Done (positive) • RT-PCR + ve • Mild No change Uneventful 3 mos Hogan et al, July 2021* [ 17 ] 1 DD 8/M Congenital nephrotic syndrome Asymptomatic Positive with high CT value Active; RT-PCR + ve with high CT value Done (positive) Negative No change Uneventful 44 d Tuschen et al, July 2021 [ 70 ] 1 DD 65/F IgA nephritis Moderate 3 65 d Positive Negative No change Uneventful 9 mos Kute et al, July 2021 [ 14 ••] 75 LD Median: 47 (29–72) Sex: M:23 F:52 • Not reported • Indication of early transplant: Difficult vascular access ( n = 8) and severe left ventricular dysfunction ( n = 12); Others: Financial constraint for continuing HD • Asymptomatic ( n = 17, 22.7%) • Mild ( n = 3, 6.48%) • Moderate ( n = 1, 5.20%) • Severe ( n = 7, 9.3%) ≥ 2 Median: 60 d; Increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d; P = 0.019), respectively Not mandatory COVID-19 recovered donors ( n = 16) No change Uneventful Median: 81 d (56–117) …”

Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

“…In a nutshell, all the transplantation activity carried out in the COVID-19 era was conducted as per the national guidelines [15] for transplantation. The authors also have previously documented the protocol for donor-recipient management in COVID-19 recovered donors [16] and recipients [17] in the context of living related transplantation. There was no modification in practice of induction or immunosuppressive drug regimen and the decision was based on patient's immunological profile.…”