Immunosuppression Minimization Strategy for Abo Incompatible Kidney Transplant Recipients during Covid-19 Pandemic

ABSTRACT

BACKGROUND: In the presence of COVID-19 illness immunosuppressed patients such as kidney transplant recipients (KTRs) have a higher mortality risk. ABO incompatible KTRs (ABOi - KTRs) are high-risk transplants and the use of lowdose maintenance immunosuppression during the COVID-19 pandemic is unknown. AIM OF THE STUDY To study effect of low dose maintenance immunosuppressive therapy on graft function and immunologic events in patients following ABOi-KTRs during COVID-19 pandemic. METHOD(S) We present the results of a follow-up study of eight ABOi-KTRs done in Kidney Transplant Unit at Jaslok Hospital during COVID-19 pandemic. RESULT(S) Seven (87%) of the eight patients were male, while one was female. The median age was 49 years. Prior to transplant, all patients received rituximab (500 mg) and plasmapheresis. Six (75%) patients received antithymocyte globulin (1 mg/kg) induction, while two (25%) received basiliximab. Dose of one immunosuppressive agent tacrolimus was decreased to trough level of 6 to 8 ng/ mL instead of 8 to 12 as compared to our institutional protocol in pre-covid era. Antimetabolites and steroids were used in usual doses. Although immunosuppression was decreased, no rejection episodes or infection observed up at 10 days, 1 and 3 month after discharge, and no significant changes occurred in creatinine level during same period. Acute graft dysfunction was seen in 1 patient and the severity was related to tacrolimus trough levels, which were higher. All patients recovered baseline kidney function with no mortality during follow-up. CONCLUSION(S) Our observational study suggests that the reduction of tacrolimus dose in ABOi KTRs performed during COVID-19 appears to be safe, since no patient experienced rejection episodes.