Kidney transplantation in patients with prior coronavirus disease 2019 (COVID-19)

ABSTRACT

Purpose: We describe short-term outcomes as well as peri- and post-transplant complications in patients with prior coronavirus disease 2019 (COVID-19) who subsequently underwent kidney transplantation. Methods: This was a single-center, retrospective cohort study of all recipients of isolated living- or deceased-donor kidney transplants between 4/1/2020-10/1/2020. Patients with prior PCR confirmed COVID-19 were considered candidates for kidney transplantation if they were at least 4 weeks post-infection, had resolution of symptoms, and had one negative nasopharyngeal PCR swab specimen. Standard doses of induction and maintenance immunosuppression were administered at the time of transplant and included anti-thymocyte globulin, tacrolimus, mycophenolate, and tapering corticosteroids. Patients were followed from the date of transplantation until study conclusion (11/1/2020), to compare short-term patient and allograft outcomes between those with prior COVID-19 and COVID-19 naïve controls transplanted during the same time-period. Results: 81 patients received isolated kidney transplants during the review period, 13 (16.0%) of whom had recovered from prior COVID-19 infection. The median time between COVID-19 diagnosis and transplantation was 71 (IQR=56.5-135) days, and all 10 patients who were tested had evidence of significant antibody titers to the SARS-CoV-2 spike protein. The majority of patients had mild disease (69.2%), while 3 patients required hospital admission and supplemental oxygen, and 1 patient required mechanical ventilation. Baseline characteristics were similar between COVID-19 positive and negative patients, with the exception of more Hispanic/ Latino patients in the prior COVID-19 group (53.8% vs 17.6%;p<0.01). At study conclusion, after a median follow-up of 3.6 months, patient and allograft survival were similar between COVID-19 positive and negative patients (92.3%/92.3% vs 100.0%/98.5%), and mean baseline serum creatinine was 1.5 mg/dL in both groups. One patient with prior mild COVID-19 died due to a pulmonary embolism within 1-month of transplant;however, no differences were observed in the overall rate of thromboembolism (7.7% vs 4.4%;p=0.61). Index hospital length of stay and readmission rate within 30-days of transplant were also similar between groups, but patients with prior COVID-19 did have a higher incidence of delayed extubation posttransplant (15.4% vs 1.5%;p=0.02). No cases of COVID-19 re-infection or biopsy proven allograft rejection were observed among patients with prior COVID-19. Conclusions: In our preliminary experience, patients with prior COVID-19 infection appeared to have similar short-term outcomes when compared with COVID-19 naive patients. We did observe a potential signal for increased peri-operative respiratory complications in patients with prior COVID-19, which may warrant additional monitoring and further study in multi-center cohorts.