Modification in induction immunosuppression regimens to safely perform kidney transplants amid the COVID-19 pandemic: a single center retrospective study.

Von Stein, Lauren; Witkowsky, Olya; Samidurai, Lakshmi; Doraiswamy, Mohan; Flores, Karen; Pesavento, Todd E; Singh, Priyamvada

BACKGROUND The COVID-19 pandemic has negatively impacted organ donation and transplantation across the globe. METHODS This study analyzed transplant outcomes during the pre-pandemic [PPE, 1/2019-2/2020] and pandemic era [PE, 3/2020-8/2020] based on changes in induction immunosuppression. During PPE, high immunological risk patients received 4-6 mg/kg, moderate risk 2-4mg/kg, and low risk 1-2 mg/kg of ATG. During PE, ATG doses were reduced to 3-4 mg/kg for high risk, 1-2 mg/kg for moderate, and low changed to basiliximab. Primary outcomes: biopsy-proven rejection [BPAR], de-novo donor-specific antibody [DSA], delayed graft function [DGF], infection rates, graft loss, and all-cause of mortality. RESULTS During PPE, 224 kidney transplants [KTx], 14 kidney/pancreas transplants [KP] were included, while 180 KTx, 5 KP were included for PE. Basiliximab use increased by 30% in the PE. The odds of DGF were statistically significant between PE vs PPE, OR 1.7 [1.05, 2.8, p-value=0.042]. The odds of developing DSAs and BPAR during the PE versus PPE was 0.34 [0.16, 0.71, p-value = 0.004] and OR 0.34 (0.1 to 1.1, p-value, 0.104)] respectively. Cytomegalovirus [19% in PE, 37% in PPE] and BK virus [5.4% PE vs. 16% PPE] incidence reduced during PE versus PPE. COVID-19, graft loss, and mortality were comparable between groups. CONCLUSION KTx and KP transplants were performed safely during the COVID-19 pandemic with a reduction of induction immunosuppression.