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

Abstract

The novel severe acute respiratory syndrome coronavirus 2 was identified in the late 2019 as the cause of coronavirus disease 2019 (COVID-19), an acute respiratory viral illness. Patients with chronic underlying conditions may have an increased risk of morbidity and mortality from COVID-19. Kidney transplant recipients may be at a uniquely increased risk of serious complications from COVID-19 as compared to the general population because of a chronically immunosuppressed state and a high prevalence of comorbidities like diabetes, heart disease, and lung disease. Early data suggest that the mortality of patients on dialysis may be comparable to those with kidney transplants, although more research is needed. This concise review aims to describe the epidemiology of COVID-19 in kidney transplant recipients, manifestations, appropriate management, and clinical outcomes based on the available literature. Current evidence on many of the specific antiviral measures against COVID-19 has not shown a clear-cut benefit in smaller studies and the results of several ongoing larger clinical trials are awaited. In addition, we also highlight the impact of COVID-19 on kidney transplant center practice and volumes; potential living or deceased donors, recipients; and induction immunosuppression and surgical strategies.

Estimated impact of novel coronavirus‐19 and transplant center inactivity on end‐stage renal disease‐related patient mortality in the United States

“…The development of policy regarding organ donation and transplantation in the United States has taken numerous issues into account now and for nearly three decades. 1,8,[15][16][17][18] Factors important in policy considerations have included patient-centered (donor and recipient) features such as age, race, and immunologic status, as well as system-related features such as organ procurement organization and transplant center performance measures or regulation-driven aversions to accept less-than-perfect donor organs and transplant candidates. Donor and recipient infection have always been a primary consideration, especially if potential lethal outcomes might ensue.…”

Coronavirus Disease (COVID)-19 and Diabetic Kidney Disease

“…The authors described that 32% of kidney transplant patients (13/41) required hospitalization, had a significantly higher rate of dyspnea (77% vs. 21%; p = 0.003) and had substantially more elevated baseline creatinine (median of 2.0 vs. 1.3 mg/dL; p = 0.02) compared to nontransplant patients [ 49 , 50 , 51 ]. A study describes a practical approach to manage kidney transplants in COVID-19 patients [ 52 ].…”

mTOR-Inhibition and COVID-19 in Kidney Transplant Recipients: Focus on Pulmonary Fibrosis

“…Over the last few months, a large number of kidney transplant recipients worldwide have been diagnosed with COVID-19 ( Elias et al, 2020 ; Kataria et al, 2020 ), and most of them have required intensive care unit (ICU) admission. The reported mortality rate for this patients’ population ranged between 20 and 30% ( Akalin et al, 2020 ; Alberici et al, 2020 ; Banerjee et al, 2020 ; Cravedi et al, 2020 ; Elias et al, 2020 ; Fernández-Ruiz et al, 2020 ; Pereira et al, 2020 …”