COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management

• Published in: Transplant Infectious Disease 2020-10, Vol.22 (5), p.e13378-n/a
• Main Authors: Chen, Tracy Yixin, Farghaly, Sara, Cham, Samantha, Tatem, Luis Lantigua, Sin, Jonathan H., Rauda, Roberto, Ribisi, Maria, Sumrani, Nabil
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - immunology; Acute Kidney Injury - therapy; Adult; Aged; Antimetabolites; Azithromycin; Azithromycin - administration & dosage; Calcineurin; Calcineurin inhibitors; Calcineurin Inhibitors - administration & dosage; Calcineurin Inhibitors - adverse effects; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - immunology; COVID-19 - therapy; COVID-19 Nucleic Acid Testing; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Graft Rejection - immunology; Graft Rejection - prevention & control; Humans; Hydroxychloroquine; Hydroxychloroquine - administration & dosage; Hyponatremia; Immunocompromised Host; Immunocompromised hosts; Immunosuppression; Immunosuppression - adverse effects; Immunosuppression - methods; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Inflammation; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Lymphopenia; Male; Management; Methylprednisolone; Methylprednisolone - administration & dosage; Middle Aged; New York City; Original Report; Original Reports; Pandemics; Patients; Pneumonia; Prednisone; Prednisone - administration & dosage; Prednisone - adverse effects; Public health; Renal Replacement Therapy; Respiration, Artificial; Retrospective Studies; RNA, Viral - isolation & purification; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; Signs and symptoms; Transplant Recipients; Treatment Outcome; Viral diseases; viral pneumonia; Viruses
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13378

Background The coronavirus disease of 2019, also known as COVID‐19, has been declared a global pandemic. Significant controversies exist regarding treatment modalities for this novel disease, especially in immunocompromised patients. Experience with management of COVID‐19 in kidney transplant recipients is scarce; effects of this virus on immunosuppressed individuals are not well understood. Methods We identified 30 renal transplant recipients with confirmed COVID‐19 pneumonia who were admitted to inpatient between March 2020 and April 2020. All patients received a 5‐day course of hydroxychloroquine and azithromycin; half of the patients received methylprednisolone. During hospitalization, calcineurin inhibitors and antimetabolites were held; prednisone was continued. Results Clinical presentation of flu‐like symptoms was similar to those in the general population. Hyponatremia, lymphopenia, acute kidney injury, and elevated inflammatory markers were common. Over the course of follow‐up, 23 have been discharged home with a functioning allograft and in stable condition; 4 experienced acute kidney injury requiring renal replacement therapy; 7 patients were intubated, and 6 expired. The mortality rate in our cohort was 20%. Conclusion Our findings described the characteristics and outcomes of this highly fatal illness in a multi‐ethnic kidney transplant cohort, with insights on immunosuppression management that could further our understanding of this unique disease in immunocompromised populations.