Is early COVID-19 in kidney transplant recipients concerning enough to halt transplantation? A multicenter comparative analysis from India

Meshram, Hari Shankar; Kute, Vivek B; Patel, Himanshu V; Hegde, Umapati; Das, Pratik; Sil, Keshab; Sahay, Manisha; Raju, Sree Bhushan; Chaudhary, Arpita Roy; Siddini, Vishwanath; Pathak, Vivek; Bahadur, M M; Anand, Urmila; Krishna, Amresh; Abraham, Abi; Patel, Ansy H; Mishra, Vineet; Chauhan, Sanshriti

Introduction: Limited data exists on the incidence and outcome of early coronavirus disease (COVID-19) in kidney transplantation recipients (KTR). Methods: A retrospective multicentre research was conducted across 12 centers of India. We explored the symptomatology, demographic, laboratory findings and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. Results: The incidence of early COVID-19 was 2.6% (n =22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 till May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43(31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%) and severe (13.6%). Among clinical symptoms, Dyspnea and Anosmia were frequent and in laboratory parameters neutrophil lymphocyte ratio, high sensitive C reactive protein and D- dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; p-value: 1). COVID-19 severity (23.9% vs 15.7%; p-value: 0.0001) and mortality (15.5% vs 8.5%; p-value: 0.001) among waitlisted patients (n = 1703) were higher compared to overall KTR. Conclusion: We report higher burden of COVID-19 in waitlisted patients compared to KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.