Kidney transplant recipients infected by COVID-19: Review of the initial published experience

There is an accumulating body of literature surrounding the impact of COVID-19 infection in solid organ transplant recipients. The aim of this review was to summarize the existing literature specifically in kidney transplant (KTx) recipients, with an emphasis on the epidemiology, clinical presentation, laboratory findings, post-operative outcomes, and therapeutic strategies currently employed. We identified thirty-seven studies published between January 1, 2020, and June 10, 2020, that were included in our analysis. As is reported in the general population, there is a wide variation in COVID-19 presentation among KTx patients, ranging from asymptomatic to life-threatening end-organ failure. The most common symptoms are predominantly respiratory and associated with fever. On laboratory evaluation, many patients present with lymphopenia and increased CRP, which are both associated with inferior outcomes. The majority of patients with severe symptoms have been managed with reduction of immunosuppression, including decreased doses of CNIs and withdrawal of MMF. Lastly, although there are no high-level data supporting the use of immunomodulatory drugs, such as IL-6 inhibitors, early experiences have suggested these drugs may improve outcomes in KTx patients with severe COVID-19.