COVID-19 Disease in Kidney Transplantation Recipients: A Single-Center Study (Experience of Dr. Shariati Hospital)

Manouchehr Amini; Seyedeh Fatemeh Yaghoubi; Farnaz Tavakoli; Milad Fooladgar; Esmat Abdollahpour; Aidin Shahilooy; Fatemeh  Mosayebi; Sahar Masoudi

doi:10.18502/jimc.v5i1.9568

Manouchehr Amini Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Seyedeh Fatemeh Yaghoubi Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Farnaz Tavakoli Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Milad Fooladgar Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Esmat Abdollahpour Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Aidin Shahilooy Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Mosayebi Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Sahar Masoudi Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v5i1.9568

Keywords: Covid-19, Immunosuppressive drugs, Kidney transplantation, SARS-CoV-2, Steroids

Abstract

Background: Coronavirus disease 2019 (COVID-19 disease) is caused by SARS-CoV-2. In December 2019, several outbreaks of severe and life-threatening pneumonia with unknown organism were reported in Wuhan, China and the disease spread rapidly all over the world and caused the biggest pandemic. There was no clear information regarding incidence, morbidity, and mortality rate of COVID-19 disease in kidney transplant recipients or other solid organ transplant recipients. Therefore, we designed a study to evaluate the factors that can have any impact on kidney transplant recipients infected with SARS-Cov2.

Methods: Our research was a retrospective cross-sectional study. The study population was all adult kidney transplant recipients (> 18 years old) who were hospitalized due to COVID-19 disease according to national guidelines from 1st March, 2020 to 20th April, 2020 in Shariati Hospital, Tehran, Iran. Demographic data, common clinical complaints, vital signs, types and dose of immunosuppressive drugs, comorbidity diseases, and basic laboratory tests were extracted from the medical records using a data collection form.

Results: According to the results of our investigation, mortality rate was 69.2% in kidney transplant recipients who were admitted in our hospital. No one died under the age of 47 years, while no one survived over the age of 58 years. As a result, age can be a reliable predictor of survival rate in kidney transplant recipients with COVID-19 pneumonia. All patients in non- survivors’ group were elderly and needed intubation, mechanical ventilation, and renal replacement.

Conclusion: In addition to early referral and early start of appropriate and specific treatments of COVID-19 in patients with kidney transplantation, our general advice, is discontinuation of antimetabolite drugs at admission time, dose reduction of calcineurin inhibitors, and even withdrawal of all immunosuppressive drugs except steroids in critical cases.