Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

Abstract

Introduction: Limited data exists on the incidence and outcome of early coronavirus disease (COVID-19) in kidney transplantation recipients (KTR). Methods: A retrospective multicentre research was conducted across 12 centers of India. We explored the symptomatology, demographic, laboratory findings and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. Results: The incidence of early COVID-19 was 2.6% (n =22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 till May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43(31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%) and severe (13.6%). Among clinical symptoms, Dyspnea and Anosmia were frequent and in laboratory parameters neutrophil lymphocyte ratio, high sensitive C reactive protein and D- dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; p-value: 1). COVID-19 severity (23.9% vs 15.7%; p-value: 0.0001) and mortality (15.5% vs 8.5%; p-value: 0.001) among waitlisted patients (n = 1703) were higher compared to overall KTR. Conclusion: We report higher burden of COVID-19 in waitlisted patients compared to KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.

Distinct Outcomes of Kidney Transplant Recipients With Recent COVID-19 According to the Timing of Infection

“…Previous studies on this topic mostly described small case reports. 3,4 The largest study so far described 22 KTRs with early COVID-19, in which only 1 death occurred in the short follow-up time of 28 d. 5 Our data might suggest that transplantation may not be contraindicated in asymptomatic or oligosymptomatic COVID-19-positive patients. Given the significant impact of the pandemic on patients with chronic kidney disease, the risks and benefits of transplantation should be individually assessed.…”

COVID- 19 and Transplantation in India

“…On the other hand, severity of COVID-19 infection and mortality was significantly higher in waitlisted patients on dialysis. (12) Overall, in another study from India, transplantation outcomes were comparable during the pandemic. COVID -19 infection was noted in 13.4% patients.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2021

“…To further investigate the risk of COVID-19 in newly transplanted kidney recipients, Meshram et al retrospectively analyzed KT recipients and waitlisted patients at 12 centers across India. 3 They found a 2.6% incidence of COVID-19 infection within the first 30 days after transplantation (out of 1,049 KT recipients diagnosed with COVID-19 between March 2020 and May 2021). It is important to note, however, that overall KT decreased in India during this time; only 838 KTs were performed, and 90.4% of these were living donor KTs.…”

“…Mortality from COVID-19 was found to be higher in 1,703 waitlisted patients (15.5 vs 8.5%, P = .001). 3…”