A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19.

BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.

Impact of COVID-19-associated Mucormycosis in Kidney Transplant Recipients: A Multicenter Cohort Study.

BACKGROUND: COVID-19-associated mucormycosis (CAM) is a recently emerging entity. There is a lack of reports of CAM in organ transplant recipients. METHODS: We conducted a multicenter (n = 18) retrospective research in India during November 2020 to July 2021. The purpose of this study was to explore the clinical spectrum, outcome and risk factors for mortality of CAM in kidney transplant recipients (KTRs). RESULTS: The incidence of CAM was 4.4% (61/1382 COVID-19-positive KTRs) with 26.2% mortality. The median age of the cohort was 45 (38-54) y. Twenty (32%) were not hospitalized and 14 (22.9%) were on room air during COVID-19. The proportion of postdischarge CAM was 59.1%, while concurrent CAM was reported in 40.9%. The presentation of CAM was 91.8% rhino-orbital-cerebral mucormycosis and 8.2% pulmonary with 19.6% and 100% mortality, respectively. In the univariable analysis, older age, obesity, difficulty of breathing, high-flow oxygen requirement, and delay in starting therapy were significantly associated with mortality. In the multivariable logistic regression analysis, patients requiring high-flow oxygen therapy [odds ratio (95% confidence interval) = 9.3 (1.6-51); P = 0.01] and obesity [odds ratio (95% confidence interval) = 5.2 (1-28); P = 0.05] was associated with mortality. The median follow-up of the study was 60 (35-60) d. CONCLUSIONS: We describe the largest case series of CAM in KTRs. Morality in pulmonary CAM is extremely high. Severe COVID-19 pose extra risk for the development of CAM and associated mortality. Our report will help in better understanding the conundrum and management of CAM.

Study of COVID-19 Pandemic in Representative Dialysis Population Across Mumbai, India: An Observational Multicentric Analysis.

COVID-19 has emerged as a pandemic of significance with potential to cause significant morbidity and mortality worldwide. Elderly with or without following comorbidities i.e Diabetes, hypertension, cardiac disease, chronic respiratory illnesses, chronic liver disease, CKD, malignancy and immunocompromised hosts are at increased risk of developing complicated course. Hemodialysis population hence are at increased risk for contracting the infection due to patient characteristics, environmental characteristics and procedural lapses. The current study was aimed at describing prevalence and characteristics of COVID19 in hemodialysis population across different HD centers across Mumbai. We found a prevalence rate of COVID19 in 6.4%, with 9 patients (12%) died during the study period. A fair proportion of Non covid HD patients (1.5%) also died due to lack of access to dialysis. At baseline, mean age of presentation was 54.5 years. On routine test 80% were asymptomatic at presentation. Patients with COPD, requiring ICU care and those on ventilation faired poorly. Contrary to assumption patients with underlying cardiovascular disease didn't show poor outcome. Total of 4.1% health care workers turned positive during the study period with mean age of 31 years and median of 28years. Out of them 5 (45.4%) were symptomatic. All recovered from the illness without any sequelae. Seventy two percent of healthcare workers were on Hydroxy-chloroquine chemoprophylaxis didn't reach statistical significance in preventing the infection. In our study elderly age with comorbidities had poor prognosis. We proposed extra healthcare measures to be taken in the dialysis unit presuming all as COVID suspect in the resource limited settings.