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J Nephropathol. 2022;11(2): e17232.
doi: 10.34172/jnp.2022.17232
  Abstract View: 106
  PDF Download: 59

Original Article

COVID-19 in kidney transplant recipients; an Indian experience

Bendalam Gouthami 1 ORCID logo, Nagraj D Naik 2 ORCID logo, Mahesh Bennikal 2 ORCID logo, Shankar Prasad Nagaraju 1 ORCID logo, Ravindra Prabhu Attur 1 ORCID logo, Indu Ramachandra Rao 1 ORCID logo, Vishal Shanbhag 3 ORCID logo, Manjunath Revanasiddappa 2* ORCID logo

1 Department of Nephrology, Kasturba Medical College, Manipal; Manipal Academy Higher Education, Karnataka, India
2 Department of Nephrology, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
3 Department of Critical Care, Kasturba Medical College, Manipal, Manipal Academy Higher Education, Karnataka, India
*Corresponding Author: *Corresponding author: Manjunath Revanasiddappa, Emails: doc.r.manjunath@gmail.com, , Email: nephrology@sdmmedicalcollege.org

Abstract

Introduction: Kidney transplant recipients appear to be at high risk for severe COVID-19 illness due to chronic immunosuppression and coexisting conditions.

Objectives: We aimed to study the clinical characteristics, laboratory and radiological results, treatment aspects and clinical outcomes of kidney transplant patients with COVID-19.

Patient and Methods: Twenty consecutive kidney transplant patients with COVID-19 pneumonia from two tertiary care centers from India were retrospectively studied from July 1 to Oct 31, 2020.

Results: Of 20 patients, 18 required admission; mean age was 42.8±9.39 years and 18 out of 20 (90%) were male. Symptom onset to testing time was a mean of 3.05±1.47 days. All patients were on triple immunosuppression. The median time since transplantation to COVID-19 was 3.75 years (IQR 2.37-5.41). Fever, cough and breathlessness were the most common presenting symptoms. Nine out of twenty (45%) had severe COVID-19 while six out of 20 (30%) required intensive care. Twelve (60%) patients had lymphopenia. Additionally mycophenolate was withheld in seventeen out of twenty (85 %) and enoxaparin and intravenous methylprednisolone were administered in all hospitalized patients while remdesivir was prescribed in 16 out of 20 (80%). Moreover, acute kidney injury (AKI) was seen in five out of 20 (25%) since one of died (5%). After a median hospital stay of 8.5 days (IQR 6.75-15.5), seventeen patients were discharged from the hospital.

Conclusion: COVID-19 infection in kidney transplant recipients is usually a moderate-severe form. COVID-19 should be a differential diagnosis for fever in this high-risk population however lymphopenia may not be seen in all. Antimetabolite withdrawal, intravenous steroid, anticoagulation and early remdesivir were all found to be safe and effective strategies for improving outcomes. Early diagnosis and timely treatment may decrease mortality in this high-risk population.



Implication for health policy/practice/research/medical education:

This study highlights the fact that strategies such as withdrawal of antimetabolite, intravenous steroid, thromboprophylaxis and earlyremdesivir administration were all found to be safe and effective in kidney transplant recipients and have an impact in bringing downmortality. Our study provides clinical and prognostic information that may be useful in the management of transplant patients infected withCOVID-19.

Please cite this paper as: Gouthami B, Naik DN, Bennikal M, Nagaraju SP, Attur RP, Rao IR, Shanbhag V, Revanasiddappa M. COVID-19in kidney transplant recipients; an Indian experience. J Nephropathol. 2022;11(2):e17232. DOI: 10.34172/jnp.2022.17232.


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Submitted: 03 Jun 2021
Accepted: 17 Dec 2021
ePublished: 02 Jan 2022
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