Renal allograft function in kidney transplant recipients infected with SARS-CoV 2: An academic single center experience

Abstract

Background: Kidney transplant recipients are a unique cohort in regard to SARS-CoV 2 susceptibility and clinical course, owing to their immunosuppressed state and propensity for kidney injury. The primary purpose of this study is to ascertain if, in kidney transplant recipients, SARS-CoV 2 infection impacts long term renal allograft function.

Methods: This retrospective, single-center study reviewed 53 kidney transplant recipients with a positive SARS-CoV-2 PCR at NMH from January 1, 2020 to June 30, 2020.

Results: Change in eGFR from baseline kidney function prior to infection to 90 days after the first positive SARS-CoV 2 test was +1.76%, -17.5% and -23.16% the mild, moderate and severe disease groups respectively. There was a significant decline in kidney function in the moderate and severe disease cohorts as compared to the mild disease cohort, with respective p values of p = 0.0002 and p = 0.021. Relative to the mild disease cohort, the moderate and severe disease cohorts also demonstrated significantly increased risk of developing AKI (66%, 85%), both with p values of P = 0.0001.

Conclusions: Clinically severe SARS-CoV 2 infection is associated with greater risk of acute kidney injury and greater decline in renal allograft function at 90 days post infection, compared to mild disease.

Fig 1. Racial discrepancies between NMH 2019 kidney transplant recipients and the SARS-CoV 2 positive kidney transplant recipient cohort.

Fig 2. Impact of increasing clinical SARS-CoV-2 disease severity on renal allograft function.

(a) Incidence of AKI developed over course of clinical infection in each of the three patient cohorts, represented as a percentage of the cohort total. (b) In each clinical disease severity cohort, percent change in estimated GFR (eGFR) from baseline kidney function prior to the positive SARS-CoV 2 PCR to 90 days after the positive test.

Fig 3. SARS-CoV2 negativity within 90 days of positive test of SARS-CoV2 infected kidney transplant recipient cohort organized by severity of clinical disease.

Fig 4. For differing severities of clinical disease, likelihood of rehospitalization for SARS-CoV sequela within 90 days of positive SARS-CoV 2 test.

(a) Mild disease cohort. (b) Moderate disease cohort. (c) Severe disease cohort.