Systematic Review and Meta-analysis of COVID-19 and Kidney Transplant Recipients, the South West London Kidney Transplant Network Experience

Mysore Phanish; Irina Chis Ster; Abbas Ghazanfar; Nicholas Cole; Virginia Quan; Richard Hull; Debasish Banerjee

doi:10.1016/j.ekir.2020.12.013

Systematic Review and Meta-analysis of COVID-19 and Kidney Transplant Recipients, the South West London Kidney Transplant Network Experience

Kidney Int Rep. 2021 Mar;6(3):574-585. doi: 10.1016/j.ekir.2020.12.013. Epub 2020 Dec 19.

Authors

Mysore Phanish^{1

2

3}, Irina Chis Ster⁴, Abbas Ghazanfar⁵, Nicholas Cole¹, Virginia Quan¹, Richard Hull⁵, Debasish Banerjee^{2

5}

Affiliations

¹ Renal Unit, St Helier Hospital, Epsom and St Helier University Hospitals NHS Trust, London, UK.
² Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
³ South West Thames Institute for Renal Research, St Helier Hospital, London, UK.
⁴ Institute of infection and immunity, St George's University of London, UK.
⁵ Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK.

Abstract

Introduction: There is paucity of literature comparing outcomes of kidney transplant patients with COVID-19 to that of dialysis and waitlisted patients. This report describes our data, provides comparative analysis, together with a meta-analysis of published studies, and describes our protocols to restart the transplant program.

Methods: Data were analyzed on kidney transplant, dialysis, and waitlisted patients tested positive for SARS-CoV-2 (nasopharyngeal swab polymerase chain reaction [PCR] test) between March 1, 2020, and June 30, 2020, together with a meta-analysis of 16 studies.

Results: Twenty-three of 1494 kidney transplant patients tested positive for SARS-CoV-2 compared with 123 of 1278 hemodialysis patients (1.5% vs. 9.6%, P < 0.001) and 12 of 253 waitlisted patients (1.5% vs. 4.7%, P = 0.002). Nineteen patients required hospital admission, of whom 6 died and 13 developed AKI. The overall case fatality ratio was 26.1% compared with patients on hemodialysis (27.6%, P = 0.99) and waitlisted patients (8.3%, P = 0.38). Within our entire cohort, 0.4% of transplant patients died compared with 0.4% of waitlisted patients and 2.7% of hemodialysis patients. Patients who died were older (alive [median age 71 years] vs. dead [median age 59 years], P = 0.01).In a meta-analysis of 16 studies, including ours, the pooled case fatality ratio was 24% (95% confidence interval [CI] 19%, 28%); AKI proportion in 10 studies was 50% (95% CI 45%, 56%), with some evidence against no heterogeneity between studies (P = 0.02).

Conclusions: From our cohort of transplant patients, a significantly lower proportion of patients contracted COVID-19 compared with waitlisted and dialysis patients. The case fatality ratio was comparable to that of the dialysis cohort and to a pooled case fatality ratio from a meta-analysis of 16 studies. The pooled AKI ratio in the meta-analysis was similar to our results.