COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Case Series of 22 Cases From Belgium

Devresse, Arnaud; Belkhir, Leila; Vo, Bernard; Ghaye, Benoit; Scohy, Anaïs; Kabamba, Benoit; Goffin, Eric; De Greef, Julien; Mourad, Michel; De Meyer, Martine; Yombi, Jean-Cyr; Kanaan, Nada

RATIONALE & OBJECTIVE: The world is facing a global pandemic caused by Sars-CoV-2 virus. Although kidney transplant recipients are at increased risk of viral infections, the impact of their chronic immunosuppressed status on the risk of acquiring coronavirus disease 2019 (COVID-19) and disease severity is unknown. STUDY DESIGN: All cases of COVID-19 infection in our cohort of kidney transplant recipients were prospectively monitored. Clinical features, management and outcomes were recorded. A standard strategy of immunosuppression minimization was applied: discontinue the antimetabolite drug and reduce trough levels of calcineurin or mTOR inhibitors. Unless contraindicated, hydroxychloroquine was administered only to hospitalized patients. SETTING & PARTICIPANTS: 22 COVID-19 infections were diagnosed in our cohort of 1200 kidney transplant recipients. RESULTS: Most common initial symptoms included fever, cough, or dyspnea. Eighteen patients (82%) required hospitalization. Of those patients, 3 had everolimus-based immunosuppression. Chest computerized tomography (CT) at admission (performed in 15 patients) showed mild (n=3), moderate (n=8), extensive (n=1), severe (n=2), and critical (n=1) involvement. Immunosuppression reduction was initiated in all patients. Hydroxychloroquine was administered to 15 patients. Eleven patients required supplemental oxygen; 2 of them were admitted to an intensive care unit (ICU) with mechanical ventilation. After a median of 10 days, 13 kidney transplant recipients were discharged, 2 were hospitalized in non- ICU, 1 was in ICU, and 2 patients had died. LIMITATIONS: Small sample size and short follow-up. CONCLUSIONS: Clinical presentation of COVID-19 infection was similar to that reported in the general population. A standard strategy of immunosuppression minimization and treatment was applied, with 11% mortality among kidney transplant recipients hospitalized with COVID-19.