ABSTRACT
Purpose: Kidney transplant recipients are at increased risk of severe disease and death caused by Coronavirus-19 infection. The role of immunosuppressive medications in the clinical presentation, disease course, and outcomes is not well understood. Methods: We analyzed kidney transplant recipients diagnosed with Coronarvirus-19 infection during the initial infection surge requiring hospitalization at two large transplant centers in New Orleans, LA, between February 1, 2020, and April 30, 2020. Patient presentation, clinical course, kidney transplant function, and postdischarge details were included in this analysis. Results: Twenty-three kidney transplant recipients hospitalized with Coronavirus-19 infection were included in the study. The majority of the patients were black (95.7%). Diabetes, hypertension, and obesity were present in at least 50% of the patients. The most common presenting symptom was fever, present in 52.2% of patients. All patients were managed with a reduction in immunosuppression. 60.9% of patients received azithromycin, 47.8% received hydroxychloroquine, 8.7% received remdesivir, and 8.7% received IV methylprednisolone pulse. The average length of stay was approximately 4.5 days (range 2 to 18 days). 73.9% of the patients sustained acute kidney injury, with an average peak serum creatinine of 3.81 mg/dL. 26% of the patients required renal replacement therapy. 77% of patients developed proteinuria (at least +1 proteinuria on urinalysis). 37.5% of patients required mechanical ventilation, and of these, 77.8% died. Overall, 30.4% of patients died of Coronavirus-19 infection-related complications during admission. Of the 16 patients discharged, the average serum creatinine during the first follow-up visit was 2.09 mg/dL compared with an average preadmission serum creatinine of 1.76 mg/dL. Conclusions: During the initial Coronavirus-19 infection surge in New Orleans, we noted that kidney transplant recipients had initial symptoms similar to the general population. However, we recorded a high incidence of acute kidney injury and the need for renal replacement therapy. Patients who required mechanical ventilation had a high mortality rate. There was an over-representation of black patients.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is caused by Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Kidney transplant recipients are at a higher risk for complications due to comorbid conditions and concurrent immunosuppression. We like to describe a small cohort of kidney transplant recipients with COVID-19 Methods: A single-center, retrospective observational cohort study describing short term outcomes of COVID-19 infection in kidney transplant recipients. Results: A total of 8 kidney transplant recipients were diagnosed with COVID-19 with a mean age of 58 yrs (26-78), predominantly African American (7/8), mean durationfrom transplant 3.5 yrs (1.5-11 yrs). All patients have HTN (8/8), half the patients have Diabetes mellitus-2 (4/8). Common presenting symptoms are fever and shortness of breath. 6/8 patients required hospitalization. 8/8 patients were managed with a reduction of immunosuppression, primarily by decreasing the dose or holding the anti-proliferative agent. 1/8 patients died, 4/6 discharged from hospital, 1/6 still admitted to the hospital with respiratory failure. 5/6 patients required supplemental oxygen. 2/6 patients required ICU stay and 1/6 required mechanical ventilation and renal replacement therapy. 3/6 hospitalized patients received hydroxychloroquine/ Azithromycin combination and 1/6 received Remdesivir. Median hospital stay is 5 days with a mean of 9 days. The patient who required mechanical ventilation and renal replacement is the only recipient who died from COVID-19 at our transplant center. Conclusions: COVID-19 is a novel infection primarily presenting with fever and shortness of breath. The course of illness appears to be severe with the majority of patients requiring supplemental oxygen and a third of hospital admitted patients required ICU stay. Reduction of immunosuppression appears to be helpful, however, no control group available. COVID-19 affected population is predominantly African American (7/8) and older recipients with age > 50 yrs (7/8).