Kidney Transplantation in the Times of COVID-19 - A Literature Review

Ann Transplant. 2020 Jul 24:25:e925755. doi: 10.12659/AOT.925755.

Abstract

Kidney transplantation at the time of the COVID-19 pandemic is challenging. Modifying the immunosuppression protocols is controversial and not evidence based. In this study, we aim to review the published literature of kidney transplant recipients who encountered COVID-19. A literature review was performed using PubMed, ScienceDirect, and World Health Organization databases to identify relevant English-language articles published up to May 7, 2020. There were 24 articles that reported 129 kidney transplant recipients who encountered COVID-19. The age mean was 54.2 years with 73.7% as males. The most commonly reported presentations in order were fever (82.3%), cough (58%), shortness of breath (33.2%), and fatigue (30.7%). Acute kidney injury was observed in 34.1% of patients. Kidney transplant patients encountered COVID-19 were maintained on tacrolimus (Tac, 92%), mycophenolate mofetil (MMF, 78.8%), and prednisone (Pred, 77%) and were manage by holding MMF in 79.1% of patients and holding Tac in 34.4% of patients. In all, 20% of patients needed Intensive Care Unit (ICU) admission and 24.6% of patients required mechanical ventilation. In all, 18.8% of patients had died compared to the reported general population COVID-19 mortality of 3.4%. The clinical presentation of COVID-19 in kidney transplant recipients may be different from the general population with a higher rate of severe disease, complications including renal failure, and mortality.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / surgery
  • Adult
  • COVID-19
  • Cause of Death*
  • Coronavirus Infections / epidemiology*
  • Databases, Factual
  • Female
  • Global Health*
  • Graft Survival
  • Humans
  • Immunosuppression Therapy / methods
  • Incidence
  • Infection Control / methods*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / methods
  • Kidney Transplantation / mortality
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Pandemics / statistics & numerical data*
  • Patient Selection
  • Pneumonia, Viral / epidemiology*
  • Prognosis
  • Risk Assessment
  • Survival Analysis
  • World Health Organization