Kidney transplantation and COVID-19 renal and patient prognosis

Abstract

Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.

Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis

“…The variation in CFR might associate with the relatively low national COVID-19 prevalence in China of the Western Pacific region compared to other included countries [ 3 ]. There was no difference in CFR among different RRT modalities which might relate to the lack of association of COVID-19 mortality and immunosuppression regimen [ 66 ], and surrogates in kidney transplant patients [ 67 ]. Subgroup analysis provided a 14.87% case fatality rate in HD patients which was lower than the 25.7% case fatality rate in HD patients from another meta-analysis [ 58 ].…”

Natural products and phytochemicals as potential anti‐SARS‐CoV‐2 drugs

“…It has been demonstrated that patients with acute renal injury have a higher mortality rate. ACE2 is strongly expressed in the kidneys (Mizuiri & Ohashi, 2015 ; Toapanta et al, 2021 ). A decrease in ACE2 and an enhancement in ACE expression might eventually lead to renal damage in diabetes (Mizuiri & Ohashi, 2015 ).…”

Renal involvement in COVID-19: focus on kidney transplant sector

“…Renal transplant patients with COVID-19 age nearly 60, and two-third of them are males. Comorbidities reflect patients' age (diabetes, hypertension, cardiovascular and pulmonary diseases) and are frequently serious being transplanted subjects under immunosuppressive therapy to prevent rejection [50,[62][63][64][82][83][84][85]; this frequently leads COVID-19 toward a severe course [85].…”