COVID-19 Infection Post-Transplant: What is the Collateral Damage to the Graft? A Case for Pre-Transplant Vaccination

ABSTRACT

Purpose: COVID-19 produces an unpredictable immune reaction and is challenging to manage during active infection and post-infection, in kidney transplant (KTX) recipients. The first peak of the COVID-19 pandemic occurred in South Carolina (SC) starting in May 2020. The aim of this evaluation was to identify the impact of COVID-19 infection on KTX recipient outcomes starting at the peak of the pandemic. Method(s) This was a retrospective, observational evaluation performed as part of the quality assessment performance improvement program. Patients >= 18 years, who underwent a KTX, were managed by our center, and developed a COVID-19 infection in the post-transplant period were included. Patients were further divided into two groups, depending on the time from transplant as of May 2020. Descriptive statistics, including Chi squared, Fischer's Exact, and T-tests, were used to evaluate the data using IBM SPSS Statistics. An immunosuppression (IS) adjustment was defined as a reduction in dose, due to the presence of an acute viral illness. Result(s) From June 2020 to September 2021, 60 patients were identified to have COVID-19. Patients who were <1-year from transplant had a higher incidence of COVID-19 in the first 3 months post-transplant and an increased rate of hospital admission (p = 0.02). 22 patients (79.6%) <1-year from transplant, required an adjustment to IS versus 16 patients (50%) who were >1-year from transplant. 20% (12/60) of patients died post-COVID-19 versus the SC mortality rate of 1.7% as of 11/2021, based on confirmed deaths/cases (12,292/734,555). Rejection post- COVID-19 occurred in 2/60 patients, see Table 2. Conclusion(s) In KTX recipients <1-year post transplant, an earlier diagnosis of COVID-19 in the post-transplant period, increased IS adjustment, and a higher incidence of hospital admission was observed. This data was used to justify the requirement for a COVID-19 vaccine prior to transplant listing and for all patients currently on the waiting list.