Effects of immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19

Alfano, G.; Damiano, F.; Fontana, F.; Ferri, C.; Giaroni, F.; Melluso, A.; Montani, M.; Morisi, N.; Plessi, J.; Tei, L.; Giovanella, S.; Ligabue, G.; Mori, G.; Guaraldi, G.; Magistroni, R.; Cappelli, G.

Kidney transplant (KT) recipients with COVID-19 are at high risk of poor outcomes because of comorbidities and long-term immunosuppressive therapy (IST). There are little data on the effect of IST reduction and early graft function after COVID-19. We conducted a retrospective study on 45 consecutive KT recipients followed at the University Hospital of Modena who tested positive for COVID-19 by RT-PCR analysis. We detailed clinical management and outcomes of these patients. Median age of patients was 56.1 (interquartile range, [IQR] 47.3-61.1) years with a predominance of male (64.4%) and patients of Caucasian origin (91.1%). Kidney transplantation vintage was 10.1 (2.7-16) years, and more than half (55.6%) was on triple IST. Therapeutic management included antimetabolite (62.8%) and calcineurin inhibitor withdrawal (22.2%), and suspension of IST in severely ill patients. Of the 45 patients, 88.9% became symptomatic and 40% required hospitalization. Overall mortality accounted for 17.8% (n=8). There were no differences in outcomes between full- and reduced-dose IST at the end of follow-up. Overall, early graft function after COVID-19 showed a stable and unmodified kidney function in 95% of survivors. Risk factors for death were age (odds ratio [OR]: 1.19; 95% CI: 1.01-1.39), and years spent on immunosuppression (OR: 1.96; 95% CI: 0.38-10.03-4.9). One patient experienced symptomatic reinfection with COVID-19 after primary infection and anti-SARS-CoV-2 mRNA vaccine. COVID-19 impacted the graft and general survival of KT recipients. Short-term graft outcome after COVID-19 was favorable in most survivors. Age and transplantation vintage are independent predictors of death in our patients.