Systematic review and meta-analysis of COVID-19 and kidney transplant recipients, the South West London Kidney Transplant Network experience

Phanish, Mysore; Ster, Irina Chis; Ghazanfar, Abbas; Cole, Nicholas; Quan, Virginia; Hull, Richard; Banerjee, Debasish

INTRODUCTION: There is paucity of literature comparing outcomes of kidney transplant patients with Covid-19 to that of dialysis and waitlisted patients. This report describes our data, provides comparative analysis, together with meta-analysis of published studies and describes our protocols to restart the transplant programme. METHODS: Data were analysed on kidney transplant, dialysis and waitlisted patients tested positive for SARS-CoV-2 (naso-pharyngeal swab PCR) between March 1, 2020 and June 30, 2020 together with meta-analysis of 16 studies. RESULTS: 23/1494 kidney transplant patients tested positive for SARS-CoV-2 compared to 123/1278 haemodialysis patients (1.5% vs 9.6%, p<0.001), 12/253 waitlisted patients (1.5% vs 4.7%, p=0.002). 19 required hospital admission, 6 died and 13 developed AKI. Overall case fatality ratio was 26.1% compared to patients on haemodialysis (27.6%, p=0.99) and waitlisted patients (8.3%, p=0.38). Within our entire cohort, 0.4% of transplant patients died compared to 0.4% of waitlisted patients and 2.7% of haemodialysis patients. Patients who died were older [Alive (median 71years) vs. Dead (median 59years), p=0.01]. In meta-analysis of 16 studies, including ours, pooled case fatality ratio was 24% [95%CI (19%, 28%)]; AKI proportion in 10 studies was 50% [95%CI (45%, 56%)], with some evidence against no heterogeneity between studies (p=0.02). CONCLUSIONS: From our cohort of transplant patients, a significantly lower proportion of patients contracted COVID-19 compared to waitlisted and dialysis patients. The case fatality ratio was comparable to that of dialysis cohort and pooled case fatality ratio from meta-analysis of 16 studies. The pooled AKI ratio in the meta-analysis was similar to our experience.