Assessment of clinical outcomes in renal transplant recipients with COVID-19

Abstract

The coronavirus disease 2019 (COVID-19) has affected more than a hundred million individuals and caused more than three million deaths worldwide. Specific risk groups were defined for increased risk of mortality and morbidity in COVID-19, and renal transplant recipients are at a significantly increased risk regarding outcomes due to their immunosuppressed conditions. This study evaluated the general characteristics of kidney transplant recipients with COVID-19 infection. Among 1257 transplant cases, 56 had COVID-19 infection, and 23 (41\%) were hospitalized during the 9-month study period. Among all COVID-19 cases, 58\% were male with a mean age of 45.5 (+/- 13.2, 19-71) years, and the most frequent comorbidities were hypertension (70.9\%) and diabetes (23.6\%). Hospitalized patients were older (p = 0.03) and had higher rates of hypertension (p = 0.008), diabetes (p = 0.002), and ischemic heart disease (p = 0.03). Therapeutic management included antimetabolite withdrawal and prednisolone increase in 71\%, calcineurin inhibitor withdrawal in 8\% and decrease in 58\%, hydroxychloroquine in 17\%, tocilizumab in 3\%, and antivirals in 67\% of patients. Acute kidney injury and respiratory failure developed in 34\% and 85\%, respectively. The mortality rate was 23\%. These results emphasized that the COVID-19 infection in renal transplant recipients significantly increases the risk of morbidity and mortality. Therefore, these patients should be intervened earlier and monitored closely to prevent poor outcomes.