The Full Spectrum of COVID-19 Development and Recovery Among Kidney Transplant Recipients

Abstract

Background. Coronavirus disease 2019 (COVID-19) fatality rate is high among kidney transplant recipients. Among survivors, kidney outcomes, seroconversion, and persistence of viral shedding are unexplored. Methods. Single-center prospective cohort study including data from kidney transplant recipients with confirmed COVID-19 between March 20, 2020 and July 31, 2020. Outcomes were adjudicated until August 31, 2020 or the date of death. Results. There were 491 patients with COVID-19 among the 11 875 recipients in follow-up. The majority were middle aged with ≥1 comorbidities. Thirty-one percent were treated at home, and 69% required hospitalization. Among the hospitalized, 61% needed intensive care, 75% presented allograft dysfunction, and 46% needed dialysis. The overall 28-day fatality rate was 22% and among hospitalized patients it was 41%. Age (odds ratio, 3.08; 95% confidence interval, 1.86-5.09), diabetes mellitus (odds ratio, 1.69; 95% confidence interval, 1.06-2.72), and cardiac disease (odds ratio, 2.00; 95% confidence interval, 1.09-3.68) were independent factors for death. Among the 351 survivors, 19% sustained renal graft dysfunction, and there were 13 (4%) graft losses. Biopsy (n = 20) findings were diverse but decisive to guide treatment and estimate prognosis. Seroconversion was observed in 79% of the survivors and was associated with disease severity. Persistence of viral shedding was observed in 21% of the patients without detectable clinical implications. Conclusions. This prospective cohort analysis confirms the high 28-day fatality rate of COVID-19, associated primarily with age and comorbidities. The high incidence of allograft dysfunction was associated with a wide range of specific histologic lesions and high rates of sequelae and graft loss. Seroconversion was high and the persistence of viral shedding deserves further studies.

The clinical course of hospitalized moderately ill COVID-19 patients is mirrored by routine hematologic tests and influenced by renal transplantation

“…In KT patients, the loss of graft function is one of the main outcomes in COVID-19 patients who have been studied [ 25 , 26 ]. Indeed, in our cohort, renal replacement therapy (RRT) was needed in 40% of KT patients, in agreement with a large Brazilian study of COVID-19 in KT patients reporting that 45% of patients needed RRT [ 6 ]. Moreover, acute kidney injury was reported in 45% of hospitalized patients in a French cohort and in 52% of 144 patients of a multicenter cohort of KT recipients with COVID-19 [ 26 , 31 ].…”

“…Thirty-one percent of these patients were treated at home. Among the hospitalized, 61% needed intensive care and 41% died [ 6 ].…”

Clinical Impact, Reactogenicity, and Immunogenicity After the First CoronaVac Dose in Kidney Transplant Recipients

“…Kidney transplant recipients have shown 20%–30% COVID-19-associated fatality rates, 2 have been excluded in vaccine trials, and had no early priority for vaccination. Therefore, this single-center, prospective, 12-mo follow-up study was designed to assess clinical impact, reactogenicity, and immunogenicity of CoronaVac.…”

Organ transplantation and COVID-19

“…We identi- In the same study, it was observed that among the patients who recovered from COVID-19, 19% presented permanent dysfunction of the graft and 4%, loss of the graft. 13 Transplantation in infected candidates and use of organs from donors with COVID-19 are currently only recommended after resolution of the clinical symptoms and with a negative RT-PCR result. Nonetheless, cases of inadvertent transplantation of organs from asymptomatic donors who showed positive RT-PCR results, without transmission to the recipient, have been reported.…”