COVID-19 in Kidney Transplant Recipients: Report of 22 Cases

COVID-2019 is a respiratory infection disease that was first identified in Hubei province, China, at the end of 2019. In this study, we analyzed patient characteristics, management strategies, and prognosis of COVID-19 in a cohort of kidney transplant recipients followed at our center in Tunisia.

In this retrospective, descriptive, and analytic study, we included all kidney transplant recipients diagnosed with COVID-19 and hospitalized in our department between March 2020 and December 2021.

Our study included 22 patients. Median age at the time of detection of SARS-CoV-2 positivity was 43.5 years. Patients were predominantly men (78.3%). Hypertension was the most common comorbidity (54.5%). Median time from transplant to COVID-19 infection was 8 years. The most common symptoms were fatigue and myalgia reported by 19 patients (86.4%), followed by anorexia, cough, and headache in 13 (59%), 15 (68.2%), and 10 (45.5%) patients, respectively. On admission, the most prevalent biologic findings were lymphopenia (77.3%), elevated C-reactive protein (77.3%), and increased levels of ferritin (77.3%). On admission, 18 patients (81.8%) had worsening graft function with a median serum creatinine level of 168 μmol/L. Ground-glass opacity was the most common radiologic finding. Immuno-suppressive treatments were adjusted in 17 patients (77.3%). Nine patients (41%) were given oxygen supplementation. Severe SARS-CoV-2 infection was noted in 6 patients (27.3%). During the study period, 2 patients died (9%), 4 were discharged with home monitoring program (19%), and the remainder (72%) completely recovered.

Kidney transplant recipients with SARS-CoV-2 pneumonia may present with a heterogeneous range of diseases. Kidney transplant recipients, who are immunocompromised, had high mortality and acute kidney injury rates. To date, the ideal therapeutic modalities remain unclear.