COVID-19 in Renal Transplant Recipients: Case Series and a Brief Review of Current Evidence

Abstract

By April 26, 2020, infections related to coronavirus disease 2019 (COVID-19) affected people from 210 countries and caused 203,818 reported deaths worldwide. A few studies discussed the outcome of COVID-19 in kidney transplant recipients. This short series demonstrates our experience in managing COVID-19 disease in renal transplant patients in the absence of strong evidence. We report 8 cases of kidney transplant recipients infected with COVID-19 (median age = 48.5 years; range = 21–71 years), including 4 males and 4 females. The most frequently associated comorbidity was hypertension. The most common presenting features were fever and cough. The main radiological investigation was a portable chest X-ray. Other common features included lymphopenia, high C-reactive protein, and a very high ferritin level. Overall, 1 patient was managed as an outpatient, the remaining 7 required hospital admission, 1 of them referred to the intensive therapy unit. Management included supportive treatment (intravenous fluid therapy, monitoring renal function, and symptomatic treatment with or without ward-based oxygen therapy depending on oxygen saturation) and discontinuation of the antiproliferative immunosuppressive drugs. Seven patients recovered and discharged home to self-isolate. One patient required intensive care treatment and mechanical ventilation. Supportive treatment could be sufficient for the management or to be tried first. We also found that short hospital stay with self-isolation on discharge reduces the burden on the health service and protect the staff and the public.

Clinical outcomes of post‐renal transplant patients with COVID‐19 infection in the ICU: A single‐center case series

“…All our patients had undergone kidney transplantation many years back with mean duration of 8.4 years, and most of them received the kidney from live‐related donors. This contrasted with most of the literature, which states that cadaveric renal transplants and recently transplanted renal recipients were at a higher risk of acquiring COVID‐19 infection 9,10 . We also had a higher number of female patients, which is in contrast to the available literature 9,10 .…”

“…This contrasted with most of the literature, which states that cadaveric renal transplants and recently transplanted renal recipients were at a higher risk of acquiring COVID‐19 infection 9,10 . We also had a higher number of female patients, which is in contrast to the available literature 9,10 . Similarities to literature include having very high inflammatory and sepsis markers, including ferritin, C‐reactive protein, fibrinogen, and D‐dimers.…”

COVID-19 Infection Clinical Profile, Management, Outcome, and Antibody Response in Kidney Transplant Recipients: A Single Centre Experience

“…The laboratory abnormalities including lymphopenia; elevated acute biochemical markers, that is, C-reactive protein; procalcitonin; interleukin-6; D dimer; and radiological findings of ground glassing; pneumonia; and fibrosis are associated with poor prognosis [ 14 ]. The nonmodifiable clinical spectrum associated with poor outcomes includes obesity, pre-existing respiratory disease, hypertension, male gender, age >60 years, hypertension, diabetes mellitus, tobacco smoking, pre-existing cardiac diseases, and the first year after transplantation [ 3 , 5 , 15 ]. Elhadedy et al reported, in their series, that more than 90% KTRs required hospitalization, and dyspnoea was the chief complaint in 80% needing ICU service [ 15 ].…”

A Kidney Transplant Patient Who Died of COVID-19-associated Severe Acute Respiratory Distress Syndrome

“…At present, the ideal method of adjusting immunosuppressive drugs in COVID-19 patients who have undergone renal transplant remains unclear, and the discontinuation of antiproliferative drugs, such as azathioprine and mycophenolate, is considered in response to severe infections ( 10 ). Calcineurin inhibitors can be expected to suppress inflammation caused by COVID-19, and since there was a report showing that tacrolimus suppressed the replication of a coronavirus in an in vitro experiment conducted before the COVID-19 pandemic, it is believed that the dose should be either maintained or reduced ( 11 ).…”