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. 2020 Oct;22(5):e13378.
doi: 10.1111/tid.13378. Epub 2020 Jul 6.

COVID-19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Tracy Yixin Chen  1 , Sara Farghaly  1 , Samantha Cham  1 , Luis Lantigua Tatem  2 , Jonathan H Sin  1 , Roberto Rauda  3 , Maria Ribisi  1 , Nabil Sumrani  3
Affiliations

COVID-19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

Tracy Yixin Chen et al. Transpl Infect Dis. 2020 Oct.

Abstract

Background: The coronavirus disease of 2019, also known as COVID-19, has been declared a global pandemic. Significant controversies exist regarding treatment modalities for this novel disease, especially in immunocompromised patients. Experience with management of COVID-19 in kidney transplant recipients is scarce; effects of this virus on immunosuppressed individuals are not well understood.

Methods: We identified 30 renal transplant recipients with confirmed COVID-19 pneumonia who were admitted to inpatient between March 2020 and April 2020. All patients received a 5-day course of hydroxychloroquine and azithromycin; half of the patients received methylprednisolone. During hospitalization, calcineurin inhibitors and antimetabolites were held; prednisone was continued.

Results: Clinical presentation of flu-like symptoms was similar to those in the general population. Hyponatremia, lymphopenia, acute kidney injury, and elevated inflammatory markers were common. Over the course of follow-up, 23 have been discharged home with a functioning allograft and in stable condition; 4 experienced acute kidney injury requiring renal replacement therapy; 7 patients were intubated, and 6 expired. The mortality rate in our cohort was 20%.

Conclusion: Our findings described the characteristics and outcomes of this highly fatal illness in a multi-ethnic kidney transplant cohort, with insights on immunosuppression management that could further our understanding of this unique disease in immunocompromised populations.

Keywords: COVID-19; immunosuppression; kidney transplantation; viral pneumonia.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interests to disclose.

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