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Official publication of the Indian Society of Nephrology
 
ORIGINAL ARTICLE
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Clinical course and outcomes of COVID-19 in kidney transplant recipients


1 Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
2 Department of Nephrology, Apollo Hospital, Navi Mumbai, Maharashtra, India
3 Kimaya Kidney Care, Thane, Maharashtra, India
4 Yashwant Kidney Care, Pune, Maharashtra, India
5 Amardeep Kidney Care, Akola, Maharashtra, India
6 Department of Microbiology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Divya Bajpai,
Department of Nephrology, Ward no. 34a, Third Floor, Seth G. S. M. C. and K. E. M. Hospital, Parel, Mumbai – 400012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_509_20

Introduction: Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR. Methods: We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19. Results: Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1–5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21–81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies. Conclusion: COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality.


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Indian Journal of Nephrology
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