Better outcome of COVID‐19 positive kidney transplant recipients during the unremitting stage with optimized anticoagulation and immunosuppression

Abstract

Introduction COVID‐19 is an ongoing pandemic with high morbidity and mortality and with a reported high risk of severe disease in kidney transplant recipients (KTR). Aim We aimed to report the largest number of COVID‐19‐positive cases in KTR in a single center and to discuss their demographics, management, and evolution. Methods We enrolled all the two thousand KTR followed up in our center in Kuwait and collected the data of all COVID‐19‐positive KTR (104) from the start of the outbreak till the end of July 2020 and have reported the clinical features, management details, and both patient and graft outcomes. Results Out of the one hundred and four cases reported, most of them were males aged 49.3 ± 14.7 years. Eighty‐two of them needed hospitalization, of which thirty‐one were managed in the intensive care unit (ICU). Main comorbidities among these patients were hypertension in 64.4%, diabetes in 51%, and ischemic heart disease in 20.2%. Management strategies included anticoagulation in 56.7%, withdrawal of antimetabolites in 54.8%, calcineurin inhibitor (CNI) withdrawal in 33.7%, the addition of antibiotics in 57.7%, Tocilizumab in 8.7%, and antivirals in 16.3%. During a follow‐up of 30 days, the reported number of acute kidney injury (AKI) was 28.7%, respiratory failure requiring oxygen therapy 46.2%, and overall mortality rate was 10.6% with hospital mortality of 13.4% including an ICU mortality rate of 35.5%. Conclusion Better outcome of COVID‐19‐positive KTR in our cohort during this unremitting stage could be due to the younger age of patients and early optimized management of anticoagulation, modification of immunosuppression, and prompt treatment of secondary bacterial infections. Mild cases can successfully be managed at home without any change in immunosuppression.

Follow‐up of renal transplant recipients after acute COVID‐19—A prospective cohort single‐center study

“…Published studies have focused on symptoms and outcomes of acute disease in renal transplant recipients with COVID‐19 9–19,22,23 . To our knowledge, this is the first study focused on the post‐COVID‐19 outcomes in this group of patients.…”

Mucormycosis as SARS-CoV2 sequelae in kidney transplant recipients: a single-center experience from India

“…There is an extensive literature in the context of clinical profile and outcome of COVID-19 in SOT [14] including kidney [15][16][17], liver [18], lung [19], and heart [20,21]. Transplantation activity ceased around the world during the COVID-19 peak, but it is estimated that postponing transplantation will result in excess of deaths [22] and hence depending on the COVID-19 surge and available resources, the transplantation should be resumed.…”

“…Mild cases (73% vs 43%; p-value = 0.1) were higher and there were fewer cases (20% vs 9%; p-value = 0.69) with severe COVID-19 in post-COVID-19 mucormycosis. Among the laboratory profile, lymphopenia [12 (10-18) vs 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26); p-value = 0.15] and higher neutrophil-lymphocyte ratio [7 (4.6-8.3) vs 3.85 (3.3 -5.8); p-value = 0.5] was more associated with post-COVID-19 mucormycosis.…”

Coronavirus disease 2019 and kidney injury

“…Additionally, considerations for concomitant acute rejection also arise. In addition to supportive therapy and SARS-CoV-2 specific therapies, reduction of immunosuppression with particular emphasis on the antimetabolite has been widely practiced [63].…”