COVID-19 in kidney transplant recipients

Am J Transplant. 2020 Jul;20(7):1819-1825. doi: 10.1111/ajt.15967. Epub 2020 May 27.

Abstract

There is minimal information on coronavirus disease 2019 (COVID-19) in immunocompromised individuals. We have studied 10 patients treated at 12 adult care hospitals. Ten kidney transplant recipients tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, and 9 were admitted. The median age was 57 (interquartile range [IQR] 47-67), 60% were male, 40% Caucasian, and 30% Black/African American. Median time from transplant to COVID-19 testing was 2822 days (IQR 1272-4592). The most common symptom was fever, followed by cough, myalgia, chills, and fatigue. The most common chest X-ray and computed tomography abnormality was multifocal patchy opacities. Three patients had no abnormal findings. Leukopenia was seen in 20% of patients, and allograft function was stable in 50% of patients. Nine patients were on tacrolimus and a mycophenolic antimetabolite, and 70% were on prednisone. Hospitalized patients had their antimetabolite agent stopped. All hospitalized patients received hydroxychloroquine and azithromycin. Three patients died (30%), and 5 (50%) developed acute kidney injury. Kidney transplant recipients infected with COVID-19 should be monitored closely in the setting of lowered immunosuppression. Most individuals required hospitalization and presenting symptoms were similar to those of nontransplant individuals.

Keywords: clinical research/practice; infection and infectious agents - viral; kidney (allograft) function/dysfunction; kidney transplantation/nephrology.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / mortality
  • Critical Care
  • Electronic Health Records
  • Female
  • Hospitalization
  • Humans
  • Immunocompromised Host
  • Immunosuppression / adverse effects
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / surgery*
  • Kidney Failure, Chronic / virology
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • New York / epidemiology
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / mortality
  • SARS-CoV-2
  • Transplant Recipients*