Abstract
ObjectivesThe lack of effective treatments for coronavirus disease 2019 (COVID-19) has mandated the repurposing of several drugs, including antiretrovirals and remdesivir (RDV). These compounds may induce acute kidney injury and are not recommended in patients with poor renal function, such as kidney transplant (KTx) recipients. MethodsThe records of 42 KTx recipients with COVID-19 were reviewed. Some of them were receiving antiretrovirals (n = 10) or RDV (n = 8) as part of COVID-19 management. Most patients were male (71%) and their median age was 52 years. The median glomerular filtration rate in these patients was 56 ml/min. Regarding disease severity, 36% had mild disease, 19% had moderate disease, 31% had severe disease, and 12% had critical disease. Subgroups, i.e., patients receiving antiretrovirals, RDV, or no antivirals, were comparable in terms of patient age, comorbidities, and immunosuppression. ResultsSeven patients (16.6%) died during hospitalization. Acute kidney injury was found in 24% of KTx recipients at admission. Upon discharge, estimated glomerular filtration rate (eGFR) increased in 32% and decreased in 39% of the KTx recipients compared with the admission rate. The decrease was more prevalent in the RDV group (80%) compared with KTx recipients without any antiviral treatment (29%) (p < 0.05). Most patients (62%) returned to baseline eGFR values within 1 month of discharge. The proportion was similar between the patients receiving antiviral treatment and those not receiving this treatment. ConclusionsKTx recipients run a high risk of COVID-19-related renal impairment. Antivirals appear to be safe for use without major risks for kidney injury.
Highlights
The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to ravage the world and claim the lives of thousands of individuals every day
A retrospective review was performed of all patients who underwent kidney transplantation at the Clinical Institute of Urology and Renal Transplantation in Cluj-Napoca, Romania, who were alive on April 1, 2020 and became ill with COVID-19 between April 1 and October 10, 2020
A total 1467 KTx recipients were in follow-up with a functioning graft at the study centre and 42 of these contracted COVID-19 during the study period, corresponding to a prevalence of 2.86%
Summary
The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to ravage the world and claim the lives of thousands of individuals every day. The presence of multiple comorbidities, and certain medications have been repeatedly confirmed as risk factors for critical disease and negative outcomes (Cummings et al, 2020; Zhou et al, 2020). Organ transplant recipients usually present concurrent comorbidities and increased frailty, and receive long-term immunosuppressive medications, placing them at much higher risk of an unfavourable outcome (Kates et al, 2020; Ravanan et al, 2020; Oltean et al, 2020). Several randomized controlled trials have reported a significantly higher frequency of renal severe adverse events in COVID-19 patients receiving the lopinavir/ritonavir combination, in intensive care patients (Dhampalwar et al, 2020; Cao et al, 2020)
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