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

Abstract

Introduction. Experience of COVID-19 in kidney transplant recipients (KTRs) with clinical presentation, management, factors influencing mortality, and antibody response is limited. Material and Methods. A retrospective data of COVID-19 in KTRs was collected and analyzed. The mortality rate, risk factors, and antibody response were primary objectives, while the clinical presentation, laboratory indicators, and pharmacological management were secondary objectives. Results. The 67 KTRs with polymerase chain reaction (PCR) confirmed COVID-19 infection reported between 1 May 2020 and 31 December 2020; 61.2% of patients were hospitalized; and 20.9% needed ventilation. The overall mortality was 26.9%, while blood group A had 50% mortality. The treatment options and used were steroids (100%), convalescent plasma (32.8%), ivermectin (58.2%), doxycycline (55.2%), remdesivir (34.3%), tocilizumab (10.4%), antibiotics (61.2%), anti-fungals (26.9%), low molecular weight heparin (45.3%), and oral anti-coagulants (26.9%). Anti-nucleosides (mycophenolate or azathioprine) were discontinued in 76.1% and calcineurin inhibitors (CNI) in 26.9%. Significant mortality ( p < 0.001 ) was observed in patients presenting with SpO2 <94 needing ICU care, ventilation, dialysis/acute kidney injury (AKI), and empirical therapies like convalescent plasma and remdesivir. The age of survivors versus nonsurvivors was not significantly different ( p = 0.02 ). The positive blood culture, low serum albumin, high TLC, high blood urea, interleukin-6, and CT severity score ≥15 were statistically significant in nonsurvivors. Overall mortality, mortality of hospitalized patients, and mortality of ventilated patients was 27%, 44%, and 100%, respectively. The median value of SARS-CoV-2 (COVID-19) IgG antibody was 68.60 (IQR, 28.5–94.25) AU/ml in more than 90% of survivors. Conclusion. KTRs with COVID-19, needing ICU care, dialysis and ventilation support had poor outcomes. Recovered patients mounted adequate antibody response.

Clinical Profile and Outcomes of COVID-19 in Renal Transplant Recipients

“…However, in our study, RTR population appeared to have a lower mortality (13.38%), compared to the reports of transplant recipients with COVID-19 from Italy with an overall mortality rate of 25% among admitted patients (17). This was similar to the mortality of 14.6% from an Indian study conducted by Jha et al (27). Mortality was 100% in our patients who were put on mechanical ventilatory support, similar to the results demonstrated by Jasuja et al in India (28).…”

A case of COVID-19 infection in a kidney transplant recipient after receiving the single dose of COVID-19 vaccination

“…In addition, KTRs have an increased viral load for a more extended period. It is critical to monitor these patients until the viral load is negligible by polymerase chain reaction (PCR) to prevent disease spread in the community [ 18 ]. Due to the rapid progression of COVID-19, kidney transplant recipients with catastrophic COVID-19 must be hospitalized, and the need for intensive care and hemodialysis increases the risk of death [ 18 ].…”

A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India

“…The disease severity and assessment parameters were as per the Chinese Centre for Disease Control (China CDC) criteria [ 57 ]. KTRs with positive SARS-CoV-2 RT-PCR were identified as mild or severe and managed accordingly by a designated COVID-19 treating team in consultation with the treating nephrologist, as described before [ 34 ].…”

“…The use of immunosuppressive medications and the presence of multiple comorbidities puts KTRs at high risk of COVID-19 [ 29 ]. Studies reporting on the outcomes of COVID-19 in KTRs have demonstrated increased morbidity and mortality in transplant patients [ 18 – 34 ]. Our recent publication also reported a 27% mortality rate in KTRs with COVID-19, which increases to 44% in hospitalized patients and 100% in patients requiring ventilation [ 34 ].…”

“…Studies reporting on the outcomes of COVID-19 in KTRs have demonstrated increased morbidity and mortality in transplant patients [ 18 – 34 ]. Our recent publication also reported a 27% mortality rate in KTRs with COVID-19, which increases to 44% in hospitalized patients and 100% in patients requiring ventilation [ 34 ]. Following the resurgence of COVID-19 in various countries, investigators have compared the epidemiology and disease outcomes between the first, second, and in some cases, third COVID-19 waves [ 21 , 25 , 33 , 35 – 54 ].…”