Short-Term Outcomes in Transplant Recipients with Prior COVID-19

Researchers at Mount Sinai Hospital, New York, New York, conducted a study to examine short-term outcomes and peri- and post-transplant complications in patients with prior COVID-19 who subsequently underwent kidney transplantation. A. Santeusanio reported results of the single-center, retrospective cohort study during a virtual session at the 2021 American Transplant Congress in a presentation titled Kidney Transplantation in Patients with Prior Coronavirus Disease 2019 (COVID-19).

The study included all recipients of isolated living- or deceased-donor kidney transplants at the center between April 1, 2020, and October 1, 2020. Patients with prior COVID-19 confirmed on polymerase chain reaction (PCR) were deemed candidates for kidney transplantation if they were a minimum of 4 weeks post-infection, had resolution of symptoms, and had one negative nasopharyngeal PCR swab specimen.

At the time of transplant, recipients received standard doses of induction and maintenance immunosuppression, including anti-thymocyte globulin, tacrolimus, mycophenolate, and tapering corticosteroids. Patients were followed from the date of the transplant until the conclusion of the study (November 1, 2020). The researchers compared short-term patient and allograft outcomes between recipients with prior COVID-19 and COVID-19 naïve controls who received a kidney transplant during the study period.

During the study period, 81 patients received isolated kidney transplants at the center. Of those, 13 (16.0%) had recovered from prior COVID-19 infection. Median time between diagnosis of COVID-19 and transplantation was 71 days. Ten patients who were tested had evidence of significant antibody titers to the SARS-CoV-2 spike protein. Among the group with prior COVID-19, 69.2% had mild disease; three patients required hospital admission and supplemental oxygen and one required mechanical ventilation. The two groups were similar in baseline characteristics, with the exception of a greater proportion of Hispanic/Latino patients in the group with prior COVID-19 than in the control group (53.8% vs 17.6%; P<.01).

At the conclusion of the study, following a median of 36 months of follow-up, patient and allograft survival were similar between the two groups (92.3%/92.3% vs 100%/98.5%), and mean baseline serum creatinine was 1.5 mg/dL in both groups. One patient in the prior COVID-19 group (mild) died due to a pulmonary embolism within 1 month of transplantation; there were no significant differences overall in the rate of thromboembolism between the groups (7.7% vs 4.4%; P=.61).

The two groups were similar in index hospital length of stay and 30-day readmission rate; patients in the prior COVID-19 group had a higher incidence of delayed extubation post-transplant (15.4% vs 1.5%; P=.02). There were no cases of COVID-19 reinfection or biopsy proven allograft rejection among patients in the prior COVID-19 group.

In conclusion, the authors said, “In our preliminary experience, patients with prior COVID-19 infection appeared to have similar short-term outcomes when compared with COVID-19 naïve patients. We did observe a potential signal for increased peri-operative respiratory complications in patients with prior CVOID-19, which may warrant additional monitoring and further study in multi-center cohorts.”

Source: Santeusanio A, Bhansali A, Rana S, et al. Kidney transplantation in patients with prior coronavirus disease 2019 (COVID-19). Abstract of a presentation at the virtual American Transplant Congress (Abstract LB 44), June 5, 2021.