COVID‐19 in kidney transplant recipients: A multicenter experience in Istanbul

Abstract

Introduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.

A Systematic Review of COVID-19 and Kidney Transplantation

“…Of the studies with available patient demographic data, average age ranged from 45 years in Demir et al to 66 years in Rodriguez-Cubillo et al 23 , 24 The percentage of male patients ranged from 46% in Pascual et al to 79% in Bossini et al 13 , 25 …”

COVID-19 und Nierentransplantation

“…22 % ICU 42 % AKI 11 % RRT 24 % 62 % Stopp MMF 4 % Stopp CNI 36 % unverändert n. a. 11 % HCQ 2 % Toci 3 % Ecul Demir et al [ 14 ] Multizentrisch (Türkei) 40 45 97 % Hosp. 17,5 % ICU 12,5 % 100 % Stopp Antimetabolit 63 % CNI halbiert Abstoßungstherapie, CsA protektiv 100 % HCQ 45 % Favipiravir 12 % Toci Husain et al.…”

“…Eine französische Studie mit 49 Nierentransplantierten ergab höhere Hospitalisierungsraten jener Patienten, die mit Mycophenolat-Mofetil (MMF) im Vergleich zu mTOR(„mechanistic target of rapamycin“)-Inhibitoren behandelt wurden [ 5 ]. In einer türkischen Studie fand sich ein protektiver Effekt von Cyclosporin A (CsA) hinsichtlich der Mortalität bei 40 Nierentransplantierten [ 14 ]. Weder die Zeit nach Transplantation noch die Induktionstherapie scheinen einen Einfluss auf die Mortalität oder die Schwere des Verlaufs zu haben [ 6 , 7 , 11 , 12 , 17 ].…”

A propensity score-matched analysis of mortality in solid organ transplant patients with COVID-19 compared to non-solid organ transplant patients

“…Emerging data of the impact of COVID-19 in immunosupressed patients, including solid organ transplant (SOT recipients) has recently become available [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. SOT recipients may be at a greater risk for worse outcomes due to the detrimental effect of the immunosuppressive therapy, similar to other viral infections, however, while some studies reflected poorer outcomes [6,9,[16][17][18], other studies do not suggest worse prognosis compared to the non-transplant population [3][4][5]7,8,15,19].…”