COVID-19 in recent kidney transplant recipients

Abstract

As the coronavirus disease 2019 (COVID‐19) pandemic spread across the globe, transplant programs suffered a setback. We report the first experience of COVID‐19 infection within 1 month of living donor kidney transplant (LDKT). We describe 2 LDKT recipients who were detected positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection at day 19 and day 7 posttransplant. They had minimal symptoms at diagnosis and did not develop any respiratory complications or allograft dysfunction. Immunosuppression was de‐escalated; however, nasopharyngeal swab real‐time reverse transcription polymerase chain reaction (rRT‐PCR) remained positive for SARS‐CoV‐2 for a prolonged time. Younger age, absence of other comorbidities, and lower dose of anti‐thymocyte globulin (ATG) used as induction possibly contributed to good outcome in our recent LDKT recipients compared with earlier published cases of recent deceased donor kidney transplant recipients with COVID‐19.

Kidney transplant recipients infected by COVID‐19: Review of the initial published experience

“…Hydroxychloroquine sulfate and chloroquine phosphate, historically, anti-malaria drugs, have also been investigated for treatment of COVID-19 in clinical trials. 64,65 In the current study, hydroxychloroquine was used in 54.8% (121/221) of KTx patients, most frequently in those with severe symptomatology [18][19][20][21]24,27,28,[30][31][32]34,[36][37][38][39][40][41][43][44][45][46][47][48]51 , and umifenovir, alone or in combination. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41]…”

“…Most COVID‐19‐positive KTx recipients included in the analyzed literature were treated as inpatients (193/221, 87.3%). All included studies reported symptoms at the time of initial physical exam 18‐54 . Fever was the most common symptom (84.5%), followed by cough (64%), and hypoxia mandating oxygen supplementation (54%).…”

“…We excluded studies due to lack of data granularity on the KTx recipients 8,9,11‐14 and reports of pediatric, 15 dual or multiorgan transplantation 16,17 . In total, 37 studies were included in the final analysis 18‐54 . All studies were evaluated to prevent overlap of published patients and related data.…”

“…These trends are comparable to the demographics of the general KTx populations. 57 Many studies (31/37) reported the time from KTx to COVID-19 diagnosis 18,[21][22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][42][43][44][45][46][47][48][49][50][51][52][53] ; 77.4% of KTx recipients received their allograft more than 1 year before COVID-19 diagnosis (range 8 days-31 years). It is unclear whether this trend is simply a reflection of the patients with KTx or it disproportionally represents chronic transplant patients.…”

“…Laboratory evaluation was included in 33 of 37 studies. 18,19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44]46,[48][49][50][51][52][53][54] Most patients presented with lymphopenia appears to be self-limited and its clinical implications are not well described in the literature. 60 Regarding radiographic findings in KTx COVID-19-infected patients, 78.5% presented with bilateral ground-glass opacities in both chest plain radiograph and CT scan of the chest.…”