The Impact of COVID-19 on Kidney Transplant Recipients in Pre-Vaccination and Delta Strain Era: A Systematic Review and Meta-Analysis

Abstract

Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between December 1, 2019 and April 20, 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), dyspnea (48%), and gastrointestinal symptoms (28%) were predominant on hospital admission. The most common comorbidities were hypertension (83%), diabetes mellitus (34%), and cardiac disease (23%). The pooled prevalence of acute respiratory distress syndrome and acute kidney injury were 58% and 48%, respectively. Invasive ventilation and dialysis were required in 24% and 22% patients, respectively. In-hospital mortality rate was as high as 21%, and increased to over 50% for patients in intensive care unit (ICU) or requiring invasive ventilation. Risk of mortality in patients with acute respiratory distress syndrome (ARDS), on mechanical ventilation, and ICU admission was increased: OR = 19.59, OR = 3.80, and OR = 13.39, respectively. Mortality risk in the elderly was OR = 3.90; however, no such association was observed in terms of time since transplantation and gender. Fever, cough, dyspnea, and gastrointestinal symptoms were common on admission for COVID-19 in kidney transplant patients. Mortality was as high as 20% and increased to over 50% in patients in ICU and required invasive ventilation.

Acute Kidney injury and COVID-19 infection

“…Sabaghian et al [23] in the large a complete and comprehensive survey In the meta-analysis hospitalized kidney transplant recipients was much higher prevalence of AKI and hemodialysis requirement (48% and 22%, respectively) [25]. These findings are consistent with factors specific for kidney transplant recipients including lower functional reserve of kidney allograft, and the toxic effect of tacrolimus in combination with increased susceptibility to prerenal causes of renal dysfunction (dehydration, hypotension, and metabolic disarray), which are absent in the general population [25].…”

“…Notably, AKI appears to disproportionately affect racial and ethnic minorities [5,17,24,25]. A significant risk factor for AKI in COV-ID-19 infected patients is also male gender [26,23].…”

“…Higher prevalence of AKI were published in the hospitalized kidney transplant recipients and in the patients required hemodialysis (48% and 22%, respectively) [25].…”

Ethical Issues in Kidney Transplant and Donation During COVID-19 Pandemic

“…3 Based on meta-analyses of observational studies, the 30-day mortality of Covid-19 was 19% among kidney transplant recipients. 4,5 There was a trend towards lower mortality with time, approaching 14% 6 during the second half of 2020 and as low as 2% 7 during the omicron surge in 2022.…”

Overview and management of different post-COVID conditions

“…Renal transplant recipients (RTRs) are a delicate patient population due to chronic immunosuppressive therapy. Mortality rates in recent studies approached 20%, with mortality in patients requiring mechanical ventilation being around 50% (72,73). In the short-term follow-up after acute COVID- Family physicians (FP) as primary care providers are often the first point of contact for patients experiencing potential post-COVID symptoms (77).…”