A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has posed a significant challenge to physicians and healthcare systems worldwide. Evidence about kidney transplant (KTx) recipients is still limited. A systematic literature review was performed. We included 63 articles published from 1 January until 7 July 2020, reporting on 420 adult KTx recipients with confirmed COVID-19. The mean age of patients was 55 ± 15 years. There was a male predominance (67%). The majority (74%) were deceased donor recipients, and 23% were recently transplanted (<1 year). Most patients (88%) had at least one comorbidity, 29% had two, and 18% three. Ninety-three percent of cases were hospitalized. Among them, 30% were admitted to the intensive care unit, 45% developed acute respiratory distress syndrome, and 44% had acute kidney injury with 23% needing renal replacement therapy. From the hospitalized patients a total of 22% died, 59% were discharged, and 19% were still in hospital at the time of publication. Immunosuppression was reduced in 27%, discontinued in 31%, and remained unchanged in 5%. Hydroxychloroquine was administered to 78% of patients, antibiotics to 73%, and antivirals to 30% while 25% received corticosteroid boluses, 28% received anti-interleukin agents, and 8% were given immunoglobulin. The main finding of our analysis was that the incidence of COVID-19 among kidney transplant patients is not particularly high, but when they do get infected, this is related to significant morbidity and mortality.

Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

“…In our study population, most patients had at least one immunosuppressive agent withdrawn, with the exception of steroids. A recent systematic review by Marinaki et al [ 14 ], including 420 KTs with COVID-19, reported that reduction/withdrawal of immunosuppression was done in 58% patients and all immunosuppressive agents were maintained in only 5%. In our case, 80.9% of patients were managed with immunosuppression reduction, while 19.1% maintained the complete immunosuppressive regimen ( Table 2 ).…”

Influence of Officially Ordered Restrictions during the First Wave of COVID-19 Pandemic on Physical Activity and Quality of Life in Patients after Kidney Transplantation in a Telemedicine Based Aftercare Program—A KTx360° Sub Study

“…When compared to the general population, a significantly increased fatality rate in transplanted patients has been described recently [26,27]. However, in a review study on COVID-19 in KTx recipients, the general risk of COVID-19 infection was not elevated, while a higher risk for a more severe course of COVID-19 can be detected, especially in the context of existing comorbidities [28]. Thus, recommendations for increasing activities while maintaining social distance seem advisable to keep up PA levels, and following the stabilization of QoL.…”

Kidney transplantation from COVID-19 deceased donor

“…The recent published sources contain data on about 400 kidney transplant recipients with confirmed COVID-19 and less than a quarter of them were transplanted no more than one year ago. 2 , 3 , 4 Determining the probability of transmission of COVID-19 during a graft is essential to continuation of the deceased transplantation program during a pandemic. Even a total examination of all potential deceased donors for COVID-19 does not guarantee that they are not infected, because the SARS-CoV-2 rRT-PCR test using throat swab specimens can often result in false negatives due to sampling techniques, viral load of the upper respiratory tract and mutations of the virus gene.…”