Kidney Transplant Recipients Infected with Coronavirus Disease 2019: Retrospective Qatar Experience

Alkadi, Mohamad M.; Al-Malki, Hassan A.; Asim, Muhammad; Fituri, Omar M.; Hamdi, Ahmed F.; Elidrisi, Rihab I.; Rahiman, Ramzi Abdul; Elshirbeny, Mostafa F.; Othman, Muftah A.; Nauman, Awais; Ashour, Adel; Ghonimi, Tarek A.; Tohid, Hiba; Jarman, Mona E.; Hamad, Abdullah; Elshazly, Mohamed B.; Abuhelaiqa, Essa

INTRODUCTION: : This study aimed to evaluate the incidence of coronavirus disease 2019 (COVID-19) infection on kidney transplant, mortality, and risk factors associated with infection acquisition and severe illness in kidney transplant recipients with COVID-19. METHODS: : Among 693 kidney transplant recipients who reported to our center, 249 were tested for COVID-19 by throat and nasal swab reverse transcription polymerase chain reaction. Of these, 43 and 206 recipients tested positive and negative, respectively. Among the 43 positive recipients, nine were treated within an isolation facility, 25 were admitted to the hospital, and nine were admitted to the intensive care unit (ICU). Risk factors associated with positive results and ICU admission were evaluated. RESULTS: : COVID-19 was found in 6% of transplant recipients. Asian ethnicity (P=0.003), history of hypertensive nephropathy (P=0.01), AB blood group (P=0.04), and higher tacrolimus trough levels (P=0.007) were more frequent in the COVID-19 positive than in the COVID-19 negative group. ICU admission was more frequent in recipients presenting with fever, shortness of breath, and acute allograft dysfunction. Renal replacement therapy was required in 3 (7%) of 43 recipients, and mortality was reported in 1 (2.3%) recipient. Acute allograft dysfunction was an independent risk factor for severe COVID-19 (odds ratio 93.7 [95% confidence interval 2.37-3710.94], P=0.02). CONCLUSION: : Higher tacrolimus targets may be associated with COVID-19 development. Acute kidney injury during the COVID-19 course may be a sign of severe disease. Prognostication of COVID-19 severity in kidney transplant recipients is crucial for early recognition of critical illness and may ensure early intervention.