American Transplant Congress 2021
Researchers, led by S. Ismail, conducted a systematic review of published literature on clinical outcomes and management of adult kidney transplant recipients with COVID-19 with an eye toward synthesis of the evidence available on therapeutic interventions and clinical outcomes in that patient population. Results of the review were reported during a virtual session at the 2021 American Transplant Congress in a presentation titled Clinical Outcomes and Management of COVID-19 Patients among Kidney Transplant Recipients: A Systematic Review.
The literature search included PubMed, EMBASE,, and the Cochrane registry for systematic reviews, as well as clinicaltrials.gov. There was no language restriction and articles of interest were published from November 1, 2019, to August 13, 2020. Studies of other organ transplants or dual organ transplants were excluded. The primary outcome of interest was the use of therapeutics for the treatment of COVID-19, alterations of immunosuppressive regimens, and clinical progression among kidney transplant recipients with COVID-19.
The search identified 90 eligible studies representing 1052 kidney transplant recipients. Of those, 68 were case reports or case series, representing 155 kidney transplant recipients. Among the 155 patients, 44 received intravenous steroids and 55% continued their oral maintenance steroid doses. Aminoquinolines, azithromycin, antivirals, and tocilizumab were used for 100, 64, 38, and 24 kidney transplant recipients, respectively. Acute kidney injury (AKI) occurred in 56.5%; 15 required renal replacement therapy (RRT). Twenty-five patients were admitted to the intensive care unit (ICU); median length of stay in the ICU was 10 days. Median length of hospital stay was 17 days. Death occurred in 22.6% of patients. Antimetabolites were withheld or doses reduced in 90.9% of patients.
The search also identified 23 aggregate-level studies, representing 897 kidney transplant recipients. Among those patients, 26.5% died and 35.11% developed AKI, 37 of whom required RRT. Hydroxychloroquine, azithromycin, and tocilizumab were used for 813, 491, and 373 kidney transplant recipients, respectively. Antimetabolites were stopped in 51.2%, calcineurin inhibitors were stopped or doses reduced in 320 patients, and steroid dose was increased in 222 patients.
“Kidney transplant recipients diagnosed with COVID-19 present a vulnerable population with high risk of severe clinical outcomes, including AKI, ICU admission, and mortality. A careful risk-benefit assessment between the use of antiviral drugs and the interruption of maintenance immunosuppressive agents including steroids is likely to be an important factor in the treatment of COVID-19 in this group,” the researchers said.
Source: Ismail S, Banonj A, Harbi S Al, Babonj A, Almalki A, Murray E.J. Clinical outcomes and management of COVID-19 patients among kidney transplant recipients: A systematic review. Abstract of a presentation at the virtual American Transplant Congress 2021 (abstract #787), June 6, 2021.