COVID-19 after kidney transplantation: Early outcome and renal function following antiviral treatment

Elec, Alina Daciana; Oltean, Mihai; Goldis, Patricia; Cismaru, Cristina; Lupse, Mihaela; Muntean, Adriana; Elec, Florin Ioan

Objectives The lack of effective COVID-19 treatments mandated the repurposing of several drugs, including antiretrovirals (ARV) and remdesivir (RDV). These compounds may induce acute kidney injuries and are not recommended in patients with poor renal function, such as kidney transplant recipients (KTx). Methods We reviewed the records of 42 KTx with COVID-19, some of them receiving ARV (n = 10) or RDV (n = 8) as part of the COVID-19 management. Most patients were male (71%) with a median age of 52 years and median GFR 56 mL/min and had mild (36%), moderate (19%), severe (31%), and critical (12%) disease. Subgroups (patients receiving ARV, RDV, or no antivirals) were comparable regarding patient age, comorbidities or immunosuppression. Results: Seven patients (16,6%) died during hospitalization. Acute kidney injury was found in 24% KTx at admission. Upon discharge, eGFR increased in 32% and decreased in 39% of the KTx compared with the admission. The decrease was more prevalent in the RDV group (80%) compared with KTx without any antiviral treatment (29%) (p < 0.05). Most patients (62%) returned to baseline eGFR values within one month from discharge. The proportion was similar between the patients receiving antiviral treatment or not. Conclusions KTx run a high risk of COVID-19-related renal impairment. Antivirals appear safe for use without major risks for kidney injury.