Solid organ transplant (SOT) recipients run a high risk for adverse outcomes from COVID‐19, with reported mortality around 19%. We retrospectively reviewed all known Swedish SOT recipients with RT‐PCR confirmed COVID‐19 between March 1 and November 20, 2020 and analyzed patient characteristics, management, and outcome. We identified 230 patients with a median age of 54.0 years (13.2), who were predominantly male (64%). Most patients were hospitalized (64%), but 36% remained outpatients. Age >50 and male sex were among predictors of transition from outpatient to inpatient status. National early warning Score 2 (NEWS2) at presentation was higher in non‐survivors. Thirty‐day all‐cause mortality was 9.6% (15.0% for inpatients), increased with age and BMI, and was higher in men. Renal function decreased during COVID‐19 but recovered in most patients. SARS‐CoV‐2 antibodies were identified in 78% of patients at 1–2 months post‐infection. Nucleocapsid‐specific antibodies decreased to 38% after 6–7 months, while spike‐specific antibody responses were more durable. Seroprevalence in 559 asymptomatic patients was 1.4%. Many patients can be managed on an outpatient basis aided by risk stratification with age, sex, and NEWS2 score. Factors associated with adverse outcomes include older age, male sex, greater BMI, and a higher NEWS2 score.

The authors declare no conflicts of interest. M.F. designed the study, collected data, analyzed results, and reviewed the article. J.M.S. designed the study, collected data, analyzed results, and drafted the article. J.M. collected data, analyzed results, and revised the article. J.E. collected data, analyzed results, and revised the article. K.K. collected data, analyzed results, and drafted the article. A.S. collected data, analyzed results, and revised the article. H.L. collected data, analyzed results, and revised the article. M.O. designed the study, collected data, analyzed results, and drafted the article. V.F. designed the study, collected data, analyzed results, and drafted the article.

Background: Coronavirus disease 2019 (COVID-19) ranges from a mild illness to acute respiratory distress syndrome (ARDS), multiorgan dysfunction, and death. Transplant recipients are vulnerable due to comorbidities and immunosuppressants that render them susceptible to infections. The information on COVID-19 in kidney transplant recipients remains limited to small case series.Methods: A systematic literature search was conducted, and 12 case series totalling 204 kidney transplant recipients with COVID-19 were identified. Data were extracted, pooled and analysed.Results: Most patients (74%) were men. The most frequent symptoms were fever (76%), cough (64%) and dyspnoea (43%). At admission, over 70% of the patients had abnormal radiological findings. Leukocyte counts were in the lower normal range. C-reactive protein, ferritin, and D-dimer were consistently increased. Treatments included lowering immunosuppression, hydroxychloroquine, antivirals, tocilizumab and intravenous immunoglobulins. Thirty-one percent of the patients were admitted to intensive care units (ICUs), and 16% required intubation. The overall mortality was 21.2%. Patients who died were significantly older than those who survived (61 ± 12 vs. 51 ± 15, p < .01). Logistic regression revealed that the odds for death increased by 4.3% for each additional year of age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.005-1.083, p value ¼ .0265). Conclusions:No substantial conclusions could be drawn on the efficacy of any particular treatment. More rigorous patient stratification is needed when analysing and reporting data to facilitate future meta-analyses.