Identifying a Kidney Transplant Recipient COVID Phenotype to Aid Test Utilization in the Setting of Limited Testing Availability—Does One Exist?

• Published in: Transplantation proceedings 2020-11, Vol.52 (9), p.2584-2591
• Main Authors: Virmani, Sarthak, Gleeson, Shana E., Girone, Gianna F., Malhotra, Divyanshu, Cohen, Elizabeth A., Klarman, Sharon E., Asch, William S.
• Format: Article
• Language: English
• Subjects: Aged; Betacoronavirus - immunology; BK Virus - immunology; Clinical Laboratory Techniques; Coronavirus Infections - diagnosis; Coronavirus Infections - immunology; Coronavirus Infections - virology; COVID-19; COVID-19 Minisymposium: Towards a Strategic Roadmap; COVID-19 Testing; Female; Humans; Immunocompromised Host - immunology; Kidney Transplantation - adverse effects; Male; Middle Aged; Pandemics; Phenotype; Pneumonia, Viral - diagnosis; Pneumonia, Viral - immunology; Pneumonia, Viral - virology; Postoperative Complications - diagnosis; Postoperative Complications - immunology; Postoperative Complications - virology; SARS-CoV-2
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2020.05.033

The high morbidity and mortality of COVID-19 in immunocompetent patients raises significant concern for immunosuppressed kidney transplant recipients (KTRs). This level of concern, both on the part of the KTRs and transplant professionals, is heightened by a lack of prior knowledge on how Severe Acute Respiratory Syndrome 2 virus (SARS-CoV-2) may manifest differently in immunosuppressed patients. Characterizing how KTRs may present differently than the general population would allow for more targeted and timely evaluation and treatment of KTRs with COVID-19 infection. Without prior knowledge of how this virus would affect our transplant center’s delivery of care to KTRs who are SARS-CoV-2 positive or patients under investigation, and in the setting of limited testing availability, we initiated a quality assurance and improvement project (QAPI) to track KTRs followed at our transplant center through the SARS-CoV-2 testing process. Of the 53 symptomatic patients, 20 (38%) tested positive for SARS-CoV-2 either on presentation to the emergency department or referral to a designated outpatient testing center. In addition, 16 (80%) of the 20 patients who tested positive required inpatient treatment. Intriguingly, patients with a history of polyoma BK viremia (BKV) had a higher incidence of testing positive for SARS-CoV-2 compared to patients without a history of BKV (80% and 28%, respectively; P = .002). The Positive Predictive Value and Likelihood ratio was 80% and 6.6 for this association, respectively. Among our KTRs tested, those receiving belatacept had a lower likelihood of testing positive for SARS-CoV-2. This finding approached, but did not achieve, statistical significance (P = .06). •With limited testing availability, and to most efficiently utilize our transplant center resources, we started a QAPI project to identify a patient phenotype to prioritize for SARS-CoV2 testing.•Patients with history of polyoma BK viremia had a higher incidence of testing positive for SARS-CoV2 infection as compared to those without a history of polyoma BKV viremia.•Patients receiving belatacept had a lower likelihood of testing positive for SARS-CoV2 infection as compared to those on calcineurin based immunosuppression.