COVID-19 in kidney transplant recipients

Abstract

There is minimal information on coronavirus disease 2019 in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals. K E Y W O R D S clinical research/practice, infection and infectious agents -viral, kidney (allograft) function/ dysfunction, kidney transplantation/nephrology

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

“…Although renal dysfunction as reflected by decreased eGFR or increased serum levels of creatinine was not considered in the published reports as a co-morbidity, it is important to recognize that renal dysfunction of kidney transplant recipients with COVID-19 ought to be recognized as such. Nevertheless, numerous reports that we reviewed showed that patients with a decreased eGFR plus other comorbidities 39 , 41 , 43 , 44 , 47 , 48 , 52 , 55 or increased serum levels of creatinine plus other comorbidities 36 , 38 , 40 , 42 , 46 , 53 , 54 still achieved a positive outcome. Interestingly, Sharma et al recently completed a retrospective study in which they compared the clinical outcomes of COVID-19 between solid organ transplant recipients and matched nontransplant patients in their medical center, and they found the need for renal replacement therapy in the organ recipients did not affect the incidence of severe COVID-19 and the rate of short-term death 70 .…”

COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic

“…The immunosuppressive agents usually used to reduce the incidence of rejection of transplanted organs reduce also the immunological response of the patient, increasing its susceptibility to opportunistic infections [ 19 ]. All the data show the need to reduce the immunosuppression therapy in symptomatic and asymptomatic patients [ 5 , 20 – 23 ]. As we did not have any infected patient at the moment, we have administered the usual immunosuppressive therapy, at the minimum effective doses [ 24 ].…”

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

“… 13 , 42 The 3 studies from New York in kidney transplant patients reported a mortality of between 16% and 30%. 6 , 14 , 43 …”

“…Here, we propose an algorithm based upon our own experience as well as from published studies. 5 , 7 , 33 , 43 , 62 - 64 Patients with mild COVID-19 (minimal or no supplemental O2 requirement) may benefit from reduction in their target CNI trough concentration to ~75% of their previous goal. In addition, reduction of other agents such as antimetabolites (mycophenolate or azathioprine) by 50% should be considered.…”