Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York

Abstract

Background The novel SARS-CoV-2 virus has caused a global pandemic of coronavirus disease 2019 . Although immunosuppressed individuals are thought to be at an increased risk of severe disease, little is known about their clinical presentation, disease course, or outcomes.Methods We report 15 kidney transplant recipients from the Columbia University kidney transplant program who required hospitalization for confirmed COVID-19, and describe their management, clinical course, and outcomes. ResultsPatients presented most often with a fever (87%) and/or cough (67%). Initial chest x-ray most commonly showed bilateral infiltrates, but 33% had no acute radiographic findings. Patients were managed with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin. Although 27% of our patients needed mechanical ventilation, over half were discharged home by the end of follow-up.Conclusions Kidney transplant recipients with COVID-19 have presentations that are similar to that of the general population. Our current treatment protocol appears to be associated with favorable outcomes, but longer follow-up of a larger cohort of patients is needed.

Is the kidney a target of SARS-CoV-2?

“…This study also evaluated whether active replication of SARS-CoV existed in the tubular cells of postmortem patients infected with SARS-CoV by analyzing the presence of viral particles using electron transmission microscopy. The authors found that SARS-CoV was not detectable in any of the analyzed samples and suggested that renal impairment was likely related to multiorgan failure (15). This study suggested that AKI in patients with SARS-CoV could be the result of cytokine release syndrome (CRS) (68) rather than active viral replication in the kidney.…”

“…In addition, 35% of heart specimens from SARS-CoV-infected patients revealed the coexistence of viral RNA and reduced ACE2 protein expression (52). A retrospective study during the SARS-CoV outbreak found that only 6% of SARS-CoV-infected patients exhibited AKI (15). However, AKI was a fatal complication of SARS, given that almost 92% of patients with SARS with AKI died.…”

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

“…COVID-19 induces variable clinical courses in normal hosts but seems to progress more rapidly in immunocompromised hosts, with greater rates of intensive care unit admissions and death [10]. The largest series reported to date from Europe and the USA are shown in Table 1 [11][12][13][14][15][16][17]. Although there might be a bias towards selection of the most severe cases (apart from one study in which only a minority of patients had severe disease [17]), the mortality rates were between 23% and 28%, which is close to the rate of 21% reported from a cohort of 5700 hospitalized patients in New York [18], but certainly higher than the 5% usually reported for COVID-19-infected patients [11].…”

COVID‐19 in kidney transplant recipients: A multicenter experience in Istanbul

“…[1][2][3][4][5][6][7] Although uremia and kidney transplantation are not considered a risk factor in COVID-19, SARS-CoV-2 often causes a moderate or severe infection in kidney transplant recipients. [1][2][3][4][5][6][7] Lymphopenia, increased inflammatory markers, prothrombin time, and creatine phosphokinase are prognostic factors for COVID-19. 8,9 Acute kidney injury is also associated with increased morbidity and mortality in COVID-19 patients.…”