Spectrum of COVID 19 outcomes in Kidney Transplant Recipients – A Single Center Experience

Abstract Purpose We reviewed the clinical experience of kidney transplant recipients diagnosed with SARS-CoV-2 infection in order to understand the impact of the current COVID-19 pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30 to 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. Procedures In this single center retrospective observational study, medical records of all kidney transplant recipients at UCLA Medical Center were reviewed for a diagnosis of COVID-19 by PCR, followed by chart review to determine kidney transplant characteristics and clinical course. Main findings A total of 41 kidney transplant recipients were identified with COVID-19 positive PCR. Recipients had been transplanted for a median of 47 months prior to diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, Black 14.6%), on prednisone, tacrolimus and mycophenolate mofetil (95.1%, 87.8% and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the ICU. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. Conclusions COVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared to earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.