Impact of COVID-19 on renal transplant recipients

Introduction: It was essential to explore immunosuppressant management strategies and potential clinical variables associated with COVID-19 related mortality in order to provide insight for clinicians attempting to manage kidney transplant recipients during the ongoing severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) pandemic. Objectives: The aim of the study was to assess the impact of COVID-19 on post-transplant renal function and outcome of immunosuppressant management on COVID-19. Patients and Methods: This is a cross sectional observational study conducted from March 2020 to January 2022 in a tertiary care hospital in South India. Baseline characteristics, comorbidities, history of graft dysfunction, symptoms and immunosuppressant modification was noted. Outcomes of COVID-19 such as acute kidney injury (AKI), need for dialysis and post COVID-19 complications were noted. The statistics were expressed as percentage for categorical variables and mean ± SD for continuous variables. Results: Out of 400 renal transplant patients on regular follow up, 28 patients developed COVID-19. The incidence of AKI was 64.2%. Immunosuppressant dose modification was done in majority of patients [mycophenolate mofetil (28.5%), steroids (53.5%) and tacrolimus (39.2%)]. Outcomes included recovery from AKI in 61.1%, recovery from oxygen dependence in 100% patients with an overall mortality rate of 7.1% patients. About 17.8% patients developed post-COVID-19 complications. Conclusion: Immunosuppressant dose modification during COVID-19 could play a role in development of AKI; infection being an independent risk factor. Patients should be monitored for development of post-COVID-19 complications.