Abstract
Introduction Experience of COVID-19 in kidney transplant recipients (KTRs) with clinical presentation, management, factors influencing mortality, and antibody response is limited. Material and Methods. A retrospective data of COVID-19 in KTRs was collected and analyzed. The mortality rate, risk factors, and antibody response were primary objectives, while the clinical presentation, laboratory indicators, and pharmacological management were secondary objectives. Results The 67 KTRs with polymerase chain reaction (PCR) confirmed COVID-19 infection reported between 1 May 2020 and 31 December 2020; 61.2% of patients were hospitalized; and 20.9% needed ventilation. The overall mortality was 26.9%, while blood group A had 50% mortality. The treatment options and used were steroids (100%), convalescent plasma (32.8%), ivermectin (58.2%), doxycycline (55.2%), remdesivir (34.3%), tocilizumab (10.4%), antibiotics (61.2%), anti-fungals (26.9%), low molecular weight heparin (45.3%), and oral anti-coagulants (26.9%). Anti-nucleosides (mycophenolate or azathioprine) were discontinued in 76.1% and calcineurin inhibitors (CNI) in 26.9%. Significant mortality (p < 0.001) was observed in patients presenting with SpO2 <94 needing ICU care, ventilation, dialysis/acute kidney injury (AKI), and empirical therapies like convalescent plasma and remdesivir. The age of survivors versus nonsurvivors was not significantly different (p=0.02). The positive blood culture, low serum albumin, high TLC, high blood urea, interleukin-6, and CT severity score ≥15 were statistically significant in nonsurvivors. Overall mortality, mortality of hospitalized patients, and mortality of ventilated patients was 27%, 44%, and 100%, respectively. The median value of SARS-CoV-2 (COVID-19) IgG antibody was 68.60 (IQR, 28.5–94.25) AU/ml in more than 90% of survivors. Conclusion KTRs with COVID-19, needing ICU care, dialysis and ventilation support had poor outcomes. Recovered patients mounted adequate antibody response.
Highlights
Experience of COVID-19 in kidney transplant recipients (KTRs) with clinical presentation, management, factors influencing mortality, and antibody response is limited
Kidney injury is well documented with COVID-19, and KTRs are more vulnerable for rapid renal function deterioration. e immunocompromised state, posttransplant duration, age, comorbidities, treatment in a nontransplant centre, and frailty add to the risk factors for poor outcomes [1, 2]
Kidney transplant recipients with severe COVID-19 require hospitalization due to rapid disease progression, while the need for intensive care and/or haemodialysis increases the risk of mortality. e disease-associated cytokine release syndrome leads to multiorgan dysfunction including acute kidney injury (AKI) in these patients [13]. e laboratory abnormalities including lymphopenia; elevated acute biochemical markers, that is, C-reactive protein; procalcitonin; interleukin-6; D dimer; and radiological findings of ground glassing; pneumonia; and fibrosis are associated with poor prognosis [14]. e nonmodifiable clinical spectrum associated with poor outcomes includes obesity, pre-existing respiratory disease, hypertension, male gender, age >60 years, hypertension, diabetes mellitus, tobacco smoking, pre-existing cardiac diseases, and the first year after transplantation [3, 5, 15]
Summary
Experience of COVID-19 in kidney transplant recipients (KTRs) with clinical presentation, management, factors influencing mortality, and antibody response is limited. E mortality rate, risk factors, and antibody response were primary objectives, while the clinical presentation, laboratory indicators, and pharmacological management were secondary objectives. E 67 KTRs with polymerase chain reaction (PCR) confirmed COVID-19 infection reported between 1 May 2020 and 31 December 2020; 61.2% of patients were hospitalized; and 20.9% needed ventilation. Significant mortality (p < 0.001) was observed in patients presenting with SpO2
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