COVID-19 and renal allograft rejection: insight from controlled and non-controlled studies

• Published in: Renal failure 2024-12, Vol.46 (1), p.2336126-2336126
• Main Authors: Daoud, Ahmed, Soliman, Karim, Posadas Salas, Maria Aurora, Uehara, Genta, Vaishnav, Sakshi, Cheungpasitporn, Wisit, Casey, Michael J
• Format: Article
• Language: English
• Subjects: Allografts; Biopsy; COVID; COVID-19; COVID-19 - complications; Graft Rejection; Humans; Immunosuppressive Agents - adverse effects; Infections; Kidney; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Literature reviews; rejection; renal; Research Letter; Statistical analysis; transplant; Transplant Recipients; Transplantation
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/0886022X.2024.2336126

Kidney transplant recipients (KTRs), due to their immunosuppressed status, are potentially more susceptible to both the severe effects of COVID-19 and complications in their transplanted organ. The aim of this study is to investigate whether COVID-19 infection increases the risk of rejection in kidney transplant recipients (KTRs). This study involved a detailed literature review, conducted using PubMed, with the search being completed by September 7th, 2023. The search strategy incorporated a combination of relevant keywords: 'COVID', 'Renal', 'Kidney', 'Transplant', and 'Rejection'. The results from controlled and uncontrolled studies were separately collated and analyzed. A total of 11 studies were identified, encompassing 1,179 patients. Among these, two controlled studies reported the incidence of rejection in KTRs infected with COVID-19. Pooling data from these studies revealed no significant statistical correlation between COVID-19 infection and biopsy-proven rejection (  = 0.26). In addition, nine non-controlled studies were found, with rejection incidences ranging from 0% to 66.7%. The majority of these studies (eight out of nine) had small sample sizes, ranging from 3 to 75 KTRs, while the largest included 372 KTRs. The combined rejection rate across these studies was calculated to be 11.8%. In conclusion, the limited number of published controlled studies revealed no statistically significant association between COVID-19 infection and biopsy-proven rejection among KTRs. However, the broader analysis of non-controlled studies showed a variable rejection incidence with a pooled rejection rate of 11.8%. There is insufficient high-quality data to explore the association of COVID-19 infection and rejection.