Spectrum of Coronavirus Disease 2019 Outcomes in Kidney Transplant Recipients: A Single-Center Experience

Abstract

Purpose We reviewed the clinical experience of kidney transplant recipients diagnosed with severe acute respiratory syndrome coronavirus 2 infection in order to understand the impact of the current coronavirus disease 2019 (COVID-19) pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30% and 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. Procedures In this single center retrospective observational study, medical records of all kidney transplant recipients at the UCLA Medical Center were reviewed for a diagnosis of COVID-19 by polymerase chain reaction, followed by chart review to determine kidney transplant characteristics and clinical course. Main findings A total of 41 kidney transplant recipients were identified with COVID-19 positive polymerase chain reaction. Recipients had been transplanted for a median of 47 months before diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, black 14.6%), on prednisone, tacrolimus, and mycophenolate mofetil (95.1%, 87.8%, and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea, or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the intensive care unit. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. Conclusions COVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared with earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.

COVID-19 in Children with Chronic Dialysis and Kidney Transplantation

“…However, 36% of KTx recipients developed early-stage AKI (stage 1). In accordance with the present result, previous studies have demonstrated that COVID-19 associated AKI develops in 27% to 52% of KTx recipients [22,23,[27][28][29]. Taken together, these results highlight the need for caution regarding the increased risk of developing AKI in KTx recipients.…”

COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

“…Previous studies have demonstrated that COVID-19-associated AKI develops in 27 to 52% of KTx recipients [ 23 , 24 , 27 – 29 ]. In our cohort, eight out of 22 KTx recipients demonstrated AKI; none required dialysis.…”

The impact of COVID‐19 on kidney transplantation and the kidney transplant recipient – One year into the pandemic

“…In general, kidney transplant recipients infected with COVID-19 present with the same signs and symptoms as those of the general population. These include fever, cough, respiratory failure, fatigue, myalgias, and gastrointestinal symptoms [39]. Management of kidney transplant recipients has included antimetabolite withdrawal in most patients, and calcineurin inhibitor (CNI) and/or mTOR inhibitor (mTORi) withdrawal in a smaller number of patients [25,28,31,36,37,39,40].…”

“…These include fever, cough, respiratory failure, fatigue, myalgias, and gastrointestinal symptoms [39]. Management of kidney transplant recipients has included antimetabolite withdrawal in most patients, and calcineurin inhibitor (CNI) and/or mTOR inhibitor (mTORi) withdrawal in a smaller number of patients [25,28,31,36,37,39,40]. These practices of antimetabolite and/or CNI/mTORi withdrawal were universal, implemented by transplant centers in most countries.…”