COVID-19 and kidney transplantation

Abstract

The COVID-19 pandemic affects the transplant recipients since March 2020. Transplant centers quickly organized themselves to optimize the management of the immunocompromised patients and to progress in the knowledge of this new disease. To this end, a French Registry was created, which includes all solid organ transplant patients who have developed a SARS Cov2 infection. Numerous studies have been carried out using these data to describe this new disease in transplant patients, to characterize its clinical and biological risk factors and to define its prognosis. The 60 days-mortality of transplant patients hospitalized for COVID-19 was evaluated at 23% and renal failure plays a major role in the poor prognosis in addition to the classical risk factors described in the general population. The advent of vaccination has been a great relief but transplanted patients have shown a poor vaccine response keeping them at risk of severe disease even after an adapted vaccination scheme. Specific strategies was proposed in this particularly fragile population like increasing vaccine doses or using anti SARS Cov-2 monoclonal antibodies.

Keywords: COVID-19; Kidney transplant patients; Mortality; Vaccination.

Fig. 1

Survival of renal transplant patients hospitalized with COVID-19. No difference in mortality between patients hospitalized in Wave 1 (March to June 2020) and those hospitalized in Wave 2 (August to December 2020). 30-day mortality was 25.3% vs. 23.9% respectively; Log Rank, p = 0.48.

Fig. 2

Cumulative 30-day incidence of death in non-transplant patients (solid line) and kidney transplant patients (dashed line) matched on risk factors for severe Covid: non-transplant patients: 11.4% vs. kidney transplant patients: 17.9%, p = 0.0035.