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

Abstract

Summary The COVID‐19 pandemic has significantly changed the landscape of kidney transplantation in the United States and worldwide. In addition to adversely impacting allograft and patient survival in postkidney transplant recipients, the current pandemic has affected all aspects of transplant care, including transplant referrals and listing, organ donation rates, organ procurement and shipping, and waitlist mortality. Critical decisions were made during this period by transplant centers and individual transplant physicians taking into consideration patient safety and resource utilization. As countries have begun administering the COVID vaccines, new and important considerations pertinent to our transplant population have arisen. This comprehensive review focuses on the impact of COVID‐19 on kidney transplantation rates, mortality, policy decisions, and the clinical management of transplanted patients infected with COVID‐19.

Effects of immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19

“…[1] Kidney transplant (KT) recipients is a subset of the population at high risk of severe COVID-19 relate consequences due to comorbidities, consequences of chronic kidney disease (CKD) and the burden of immunosuppressive therapy (IST), which in some subjects include also therapies administered before kidney transplantation to treat glomerulonephritis or underlying autoimmune diseases. [2] Data collected so far reported that transplant recipients were at higher risk of morbidity and mortality compared to the general population [3,4]. Despite the great emphasis on IST reduction to face the potentially lethal consequences of COVID-19, no confirming data supports its beneficial effect in terms of survival or clinical and laboratory manifestations.…”

Outpatient Management of COVID-19 With Monoclonal Antibody Therapy in a Young Renal Transplant Patient

“…In solid organ transplant recipients at or further than two years post-transplant, Dale et al (2021) found their mortality rate to be 18%, compared to a global mortality rate of 2.2% in the general population [4,5]. Risk factors predisposing renal transplant recipients to COVID-19 are similar to those in the general population, including obesity, advanced age, multiple comorbid conditions, poor overall condition, and pulmonary disease [1]. A recent study by Fishman et al (2020) suggested that progression of COVID-19 in solid organ transplant patients occurred more rapidly, with a greater rate of admission to the ICU overall [1,6].…”

“…The review article by Khairallah et al (2021) provides an excellent flow diagram outlining major classifications and conceptualization of management of renal transplant patients who tested positive for COVID-19 [1]. Definitions and recommendations are summarized below in Table 1.…”

“…At baseline, solid organ transplant recipients are at an increased risk for infectious complications due to the complex immunosuppressive regimens required to keep their transplant from rejection. Data from across the world have demonstrated an increased mortality rate in renal transplant patients who have been infected with coronavirus disease 2019 (COVID-19) and required hospitalization [1]. Khairallah et al (2021) reported a mortality rate as high as 33% in the studies and registries reviewed during their research, which was mainly attributed to respiratory failure associated with the virus [1].…”

“…Data from across the world have demonstrated an increased mortality rate in renal transplant patients who have been infected with coronavirus disease 2019 (COVID-19) and required hospitalization [1]. Khairallah et al (2021) reported a mortality rate as high as 33% in the studies and registries reviewed during their research, which was mainly attributed to respiratory failure associated with the virus [1]. Thaunat et al (2020) conducted a study reviewing the mortality over the course of the pandemic in the French renal transplant population.…”