POS-905 PROSPECTIVE STUDY ON COVID-19 INFECTION IN KIDNEY TRANSPLANT RECIPIENTS IN SABAH: A PRELIMINARY RESULT

Abstract

In December 2019, a new strain of coronavirus, later named as COVID-19, was identified in Wuhan, Hubei Province, China and has since become a worldwide pandemic. There is paucity of literature on the clinical progression and outcome of kidney transplant recipients diagnosed with COVID-19. We aim to determine the clinical features, management and outcomes of COVID-19 in kidney transplant recipients This is a prospective cohort study from 1 December 2020 - 31 December 2021. All kidney transplant recipients age more than 18 years old diagnosed with COVID-19 infection, by reverse transcriptase polymerase chain reaction or rapid test kit for COVID-19 antigen, will be admitted and followed up throughout admission with clinical, laboratory data and outcomes recorded. There were a total of 7 cases of COVID-19 infection in kidney transplant recipients up until 15 September 2021. Six were males and 1 female with mean age of 52.1 years old (SD 13.2) and admission median creatinine of 124 υmol/L (IQR 46). Two patients had new-onset-diabetes mellitus after transplant (28.6%) while 4 (57.1%) had hypertension. Majority (n=6, 86%) had oral prednisolone, mycophenolate mofetil and tacrolimus as baseline immunosuppressants. Only 2 patients (28.6%) were not vaccinated while the rest were fully vaccinated with BNT162b2 where the mean days to COVID-19 infection following vaccination was 85 days. Majority (n=6, 85%) presented with respiratory symptoms such as fever, cough and/or myalgia. On presentation, 3 patients (42.9%) were diagnosed with severe illness requiring oxygen support, 2 patients (28.6%) had moderate illness, 1 (14.3%) was of mild illness and 1 was asymptomatic. Four patients (57%) developed acute kidney injury where 1 patient required hemodialysis. Three patients (42.9%) required intensive care management. Throughout the hospitalisation, 1 patient deteriorated and was ventilated while 2 required high flow nasal cannula, and another 2 required face mask oxygen support. Only 2 patients required no oxygen support throughout admission. Antimetabolite immunosuppressant was withheld for all 7 patients and patients requiring oxygen therapy (n=5) received intravenous methylprednisolone ranging from 3-7 days. Two patients received intravenous tocilizumab while 1 received oral baricitinib for additional treatment of critical COVID-19 infection. Higher admission c-reactive protein level predicts more severe COVID-19 infection (p=0.019), while age, creatinine, albumin, ferritin and vaccination status were not statistically significant in predicting severity of COVID-19. As of now, 5 patients were discharged well, 1 died due to COVID-19 complications, and 1 patient is still under intensive care giving the mortality rate of 14.3% in Sabah. This case series showed that despite being fully vaccinated, 4 out of 5 patients still suffered from severe and critically ill COVID-19 infection with 1 death making the mortality rate of 20% amongst the vaccinated group. This may be due to suboptimal antibody response in kidney transplant recipients following vaccination. Safety measures with good hand hygiene, social distancing and face mask are still critical to prevent disease transmission for kidney transplant recipient. Our report revealed that kidney transplant recipient is at risks of severe COVID-19 infection with high mortality despite being vaccinated.