COVID-19 infection in kidney transplant recipients: A multicenter experience in Istanbul

ABSTRACT

Background: Management of COVID-19 in kidney transplant recipients (KTR) should include treatment of infection and regulation of immunosuppression but there is no consensus on this issue yet. In this study, we aimed to describe our experience in KTR with COVID-19. Methods: In this retrospective cohort study, we included KTR who diagnosed with COVID-19 from five centers. The patients were categorized into two groups for the analysis. Patients had respiratory failure and multiple organ dysfunctions were defined as severe pneumonia. All other cases were classified as moderate pneumonia. The primary endpoint was all-cause mortality. Results: 40 patients (20 female) were reviewed over a median follow-up of 32 days (IQR, 14-51 days) after COVID-19. 5 patients died during the follow-up. The frequency of graft dysfunction was similar between groups (n=12 and n=2;p=0.615, respectively). The frequency of previous induction (n=18 and n=7;p=0.016, respectively) and rejection therapy (n=4 and n=3;p=0.023, respectively) was significantly increased in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Also, multivariate logistic regression analysis revealed that previous anti-rejection therapy (9.75 [95% CI, 1.223 to 77.724;P=0.032]) was the independent predictor for mortality. Conclusions: COVID-19 more commonly causes moderate or severe pneumonia in KTR. Immunosuppression should be carefully reduced in KTR. Induction therapy with lymphocyte depleting agents should be carefully avoided in KTR during the pandemic period.