Hospitalized and Outpatient Kidney Transplant Recipients with COVID-19

Authors

• Carolina Branco Division of Nephrology and Renal Transplantation, Department of Medicine
• Inês Duarte Division of Nephrology and Renal Transplantation, Department of Medicine
• Alice Santana
• José Oliveira Guerra

Abstract

Introduction: As the number of COVID-19 infection raise is expected that more kidney transplant (KT) recipients will be affected. More information is need about the clinic factors that determine severe presentation in KT recipients with COVID-19.

Methods: This is a retrospective observational single-center analysis of 18 KT recipients with confirmed SARS-CoV-2 infection between March to November of 2020.

Results: Ten patients (55.5%) needed hospitalization and 8 patients (44.4%) were managed as outpatient. Mean age was 45.3 ± 13.1 years and 61.1% were male. Hypertension was presented in 72.2%, diabetes in 33.3% and obesity in 22.1% of patients. Eleven patients (61.1%) had an identifiable sick contact. Hospitalized patients were older (52 ± 12.2 vs 37 ± 9.3 years; p value = 0.011), had lower baseline glomerular filtration rate (GFR) [39.0 (IQR 28.0 – 43.0) vs 59.0 ml/min/1.73m2 (IQR 41.3 – 101.0), p value= 0.021] and longer time since transplant (12.9 ± 6.9 vs 5.9 ± 6.5 years). Immunosuppression alteration occurred 90.0% of hospitalized patients vs 37.5% in outpatient (p value= 0.043). In hospitalized patients, 8 patients (80.0%) had acute kidney injury of which 2 patients needed renal replacement therapy. Recovery renal function was seen in 7 patients (70.0%) Hospitalized patients had a longer time to infection cure (35.6 ± 17.7 vs 21.6 ± 10.6 days).

Conclusion: Age, GFR at admission and time since transplant were associated with COVID-19 severity in kidney transplant recipients. Further research is needed to determine the impact of immunosuppression on the risk for COVID-19 infection and severity.