Coronavirus Disease 2019 in Kidney Transplant Recipients: Single-Center Experience and Case-Control Study

Abstract

\n Background\n Kidney transplant recipients (KTR) are considered high-risk for morbidity and mortality from COVID-19. However, some studies did not show worse outcomes compared to non-transplant patients and there is little data about immunosuppressant drug levels and secondary infections in KTR with COVID-19. Herein, we describe our single-center experience with COVID-19 in KTR.\n \n Methods\n We captured KTR diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by age and sex (controls).\n \n Results\n Eleven KTR were hospitalized and matched with 44 controls. One KTR and four controls died (case fatality rate: 9.1%). There were no significant differences in length of stay or clinical outcomes between KTR and controls. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%). Bacterial infections were more frequent in KTR (36.3%), compared to controls (6.8%, P=0.02).\n \n Conclusions\n In our small case series, unlike earlier reports from the pandemic epicenters, the clinical outcomes of KTR with COVID-19 were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high. Bacterial infections were more common in KTR, compared to controls.\n