COVID-19 in Kidney Transplant Recipients, Single Center Study From Turkey

In December 2019, an outbreak of COVID-19, caused by a novel SARS-CoV-2, occurred in Wuhan. Currently, COVID-19 has spread widely around the World. Although immunosuppression is associated with a severe course of covid infection, information on the first presentation, clinical findings and outcomes of COVID-19 disease in patients with kidney transplantation is limited. This study included kidney transplant recipients who were radiological and/or serological diagnosed COVID-19 in University of Health Sciences, Haydarpasa Numune Education and Research Hospital. Data from 5 patients were reviewed retrospectively. Four patients were female and the median age was 46. Four recipients had hypertension, 1 had diabetes mellitus. All the patients were taking tacrolimus except one at the time of COVID-19 diagnosis, and all of them were also taking either mycophenolate mofetil or mycophenolic acid. One patient was taking mTOR inhibitor.The most common presenting symptom was cough. All of the patients had multifocal bilateral ground-glass opacity which was compatible with viral infection with Thorax CT scans. Three patients were lymphopenic. The primary change in immunosuppression in the majority of patients was complete cessation of either mycophenolate mofetil or mycophenolic acid while reducing the tacrolimus. The mTor inhibitor dose of the patient receiving antimetabolite with mTor inhibitor was maintained. All of the patients received hydroxychloroquine (HCQ), azithromycin and ceftriaxone as treatment. Two patients recieved oseltamivir treatment. One patient was treated with azithromycin, hydroxychloroquine, ceftriaxone, favipiravir and vitamin C combination. During the follow-up, none of them had acute kidney injury and needed for intensive care. In our study, among 5 kidney transplant recipients with COVID-19, overall presentation was similar to that reported from other countries. All of our patients experienced a favorable outcome with our current treatment strategy but the small group cohort makes it difficult to say any conclusions about safety and tolerability of our protocol.