Kidney Transplantation in the Times of COVID-19 – A Literature Review

Abstract

Kidney transplantation at the time of the COVID-19 pandemic is challenging. Modifying the immunosuppression protocols is controversial and not evidence based. In this study, we aim to review the published literature of kidney transplant recipients who encountered COVID-19. A literature review was performed using PubMed, ScienceDirect, and World Health Organization databases to identify relevant English-language articles published up to May 7, 2020. There were 24 articles that reported 129 kidney transplant recipients who encountered COVID-19. The age mean was 54.2 years with 73.7% as males. The most commonly reported presentations in order were fever (82.3%), cough (58%), shortness of breath (33.2%), and fatigue (30.7%). Acute kidney injury was observed in 34.1% of patients. Kidney transplant patients encountered COVID-19 were maintained on tacrolimus (Tac, 92%), mycophenolate mofetil (MMF, 78.8%), and prednisone (Pred, 77%) and were manage by holding MMF in 79.1% of patients and holding Tac in 34.4% of patients. In all, 20% of patients needed Intensive Care Unit (ICU) admission and 24.6% of patients required mechanical ventilation. In all, 18.8% of patients had died compared to the reported general population COVID-19 mortality of 3.4%. The clinical presentation of COVID-19 in kidney transplant recipients may be different from the general population with a higher rate of severe disease, complications including renal failure, and mortality.

A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

“…Most agree that presenting symptoms are similar to those of non-transplanted patients with fever (85%), dry cough (70%), myalgia (60%), and dyspnea (57%) being the most frequently reported symptoms [ 6 , 69 ].…”

Impact of COVID-19 in solid organ transplant recipients

“…The presentation of SOT recipients with COVID‐19 appears similar to the general population. Fever (61–83%), cough (45–75%), and diarrhea (22–57%) were the most common symptoms reported 14‐16,71,75,79,80,83‐88 . Abnormalities in chest imaging occurred frequently; cohorts of SOT recipients in New York City reported abnormal chest radiographs in 96%–100% 83,84 .…”

COVID-19–Associated Graft Loss From Renal Infarction in a Kidney Transplant Recipient

“…Kidney and other transplant recipients are considered a high-risk population for severe SARS-CoV-2 infection, due to coexisting comorbid diseases and chronic immunosuppression. 2 Kidney transplant patients admitted with COVID–19 have shown a higher early mortality compared to the general population with more rapid clinical progression. 2 The international consensus has been to modify immunosuppression in patients requiring hospital admission.…”

“… 2 Kidney transplant patients admitted with COVID–19 have shown a higher early mortality compared to the general population with more rapid clinical progression. 2 The international consensus has been to modify immunosuppression in patients requiring hospital admission. The suggestion has been to stop the antimetabolite such as azathioprine, mycophenolate mofetil [MMF] or mycophenolic sodium [MPS] and to increase the dose of corticosteroids.…”

“… 4 Protocols for treating hospitalised kidney transplant recipients with severe disease have been developed and include anticoagulation, addition of/or increasing corticosteroids, omitting antimetabolites and reduction of calcineurin inhibitors [CNIs]. 2 …”