Kidney transplant recipients who had COVID-19 prior to transplant: A single-center experience

Purpose: In the early recovery phase after the initial surge of the COVID-19 pandemic, a question emerged in the context of resuming transplant activity: should a patient who had recovered from COVID-19 be eligible for transplant, and under what conditions? Here we report our early experience of patients who had recovered from COVID-19 and then subsequently underwent kidney transplantation. Methods: Patients who were known to have COVID-19 were required to be fully asymptomatic and to have a negative PCR test prior to being eligible to undergo transplant, but no specific waiting period was required. A retrospective chart review was performed on patients who underwent transplant between 6/3/2020 and 7/30/2020, allowing for at least 3 months of post-transplant follow-up. During this period we adjusted our protocol to reduce the total dose of anti-thymocyte globulin for induction, from a historical dose of 6 mg/kg, now to 4.5mg/kg in three divided doses, while the maintenance immunosuppression was unchanged. Results: In the study period, there were 10 patients who were known to have had COVID-19, by a PCR test, who then underwent kidney transplant. The average duration between the first COVID test and the date of transplant was 97 days (range 47 - 137). All patients demonstrated the presence of antibodies, at a mean duration of 96 days (range 32 - 164) after the PCR test. There were 8 males and 2 females. The average age at the time of transplant was 51.3 years (range 31.0 - 68.7). There were 7 living donors and 3 deceased donors. There were no episodes of respiratory failure and no deaths. There were no cases of biopsy-proven acute rejection, or graft thrombosis. There was 1 case of recurrent FSGS, which was treated. There was 1 graft loss relating to a severe neurologic decompensation of unclear etiology and the resulting inability to tolerate immunosuppression. This patient had a positive PCR test 42 days post-transplant, but other PCR tests before and after that point were negative. In the remaining 9 cases with functioning grafts, the average Cr at 3 months of follow-up was 1.71 mg/dL (range 1.1 - 3.89). Conclusions: In this small series with short-term follow-up, outcomes of patients who previously had COVID-19 and then underwent kidney transplant were generally good. However, caution is still advised until larger experiences and longer-term data are published.