COVID-19 in kidney transplant recipients: Single-center experience and case-control study

Hardesty, Anna; Pandita, Aakriti; Vieira, Kendra; Rogers, Ralph; Merhi, Basma; Osband, Adena J.; Aridi, Jad; Shi, Yiyun; Bayliss, George; Cosgrove, Christopher; Gohh, Reginald; Morrissey, Paul; Beckwith, Curt G.; Farmakiotis, Dimitrios

Background Kidney transplant recipients (KTR) are considered high-risk for morbidity and mortality from COVID-19. However, some studies did not show worse outcomes compared to non-transplant patients and there is little data about immunosuppressant drug levels and secondary infections in KTR with COVID-19. Herein, we describe our single-center experience with COVID-19 in KTR. Methods We captured KTR diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by age and sex (controls). Results Eleven KTR were hospitalized and matched with 44 controls. One KTR and four controls died (case fatality rate: 9.1%). There were no significant differences in length of stay or clinical outcomes between KTR and controls. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%). Bacterial infections were more frequent in KTR (36.3%), compared to controls (6.8%, P=0.02). Conclusions In our small case series, unlike earlier reports from the pandemic epicenters, the clinical outcomes of KTR with COVID-19 were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high. Bacterial infections were more common in KTR, compared to controls.