The Full Spectrum of COVID-19 Development and Recovery Among Kidney Transplant Recipients.

Cristelli, Marina P; Viana, Laila A; Dantas, Marcus T C; Martins, Suelen B S; Fernandes, Ruan; Nakamura, Monica R; Santos, Daniel W C L; Taddeo, Julia B; Azevedo, Vega F; Foresto, Renato D; Tedesco-Silva, Helio; Medina-Pestana, Jose

BACKGROUND COVID-19 fatality rate is high among kidney transplant recipients. Among survivors, kidney outcomes, seroconversion, and persistence of viral shedding are unexplored. METHODS Single-center prospective cohort study including data from kidney transplant recipients with confirmed COVID-19 between 03/20/2020 and 07/31/2020. Outcomes were adjudicated until 08/31/2020 or the date of death. RESULTS There were 491 patients with COVID-19 among the 11 875 recipients in follow-up. The majority was middle-aged with 1 or more comorbidities. Thirty-one percent were treated at home, 69% required hospitalization. Among the hospitalized, 61% needed intensive care, 75% presented allograft dysfunction and 46% needed dialysis. Overall 28-day fatality rate was 22% and, among hospitalized patients, 41%. Age (OR 3.08, 95%CI 1.86-5.09), diabetes mellitus (OR 1.69, 95%CI 1.06-2.72), and cardiac disease (OR 2.00, 95%CI 1.09-3.68) were independent factors for death. Among the 351 survivors, 19% sustained renal graft dysfunction, and there were 13 (4%) graft losses. Biopsy (n=20) findings were diverse but decisive to guide treatment and estimate prognosis. Seroconversion was observed in 79% of the survivors and was associated with disease severity. Persistence of viral shedding was observed in 21% of the patients without detectable clinical implications. CONCLUSIONS This prospective cohort analysis confirms the high 28-days fatality rate of COVID-19, associated primarily with age and comorbidities. The high incidence of allograft dysfunction was associated with a wide range of specific histologic lesions and high rates of sequelae and graft loss. Seroconversion was high and the persistence of viral shedding deserves further studies.