Vivek B Kute1, Deepak S Ray2, Dinesh Kumar Yadav3, Vivek Pathak4, Anil K Bhalla5, Suraj Godara6, Anil Kumar7, Sandeep Guleria8, Dinesh Khullar9, Sharmila Thukral2, Rabi Ranjan Sow Mondal2, Manish Jain3, Pranaw Kumar Jha3, Umapati Hegde10, Abi Abraham M11, Sonal Dalal12, Himanshu Patel1, Madan M Bahadur13, Ashay Shingare13, Ashish Sharma14, Raj Kumar Sharma15, Urmila Anandh16, Sanjeev Gulati17, Manoj Gumber18, Vishwanath Siddini19, Rushi Deshpande13, Kamal Kaswan20, Umesh Varyani21, Shailesh Kakde22, Deepesh B Kenwar14, Hari Shankar Meshram1, Vijay Kher3. 1. Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India. 2. Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India. 3. Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India. 4. Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India. 5. Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India. 6. Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India. 7. Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India. 8. Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India. 9. Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India. 10. Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. 11. Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India. 12. Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India. 13. Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India. 14. Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India. 15. Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India. 16. Department of Nephrology, Yashoda Hospital, Secunderabad, India. 17. Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India. 18. Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India. 19. Department of Nephrology, Manipal Hospital, Bangalore, India. 20. Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India. 21. Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. 22. Department of Nephrology, Jupiter Hospital, Pune, India.
Abstract
BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
BACKGROUND: There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS: We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS: Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS: Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
Authors: Jonathan S Hausmann; Julia F Simard; Jeffrey A Sparks; Michael DiIorio; Kevin Kennedy; Jean W Liew; Michael S Putman; Emily Sirotich; Sebastian E Sattui; Gary Foster; Carly Harrison; Maggie J Larché; Mitchell Levine; Tarin T Moni; Lehana Thabane; Suleman Bhana; Wendy Costello; Rebecca Grainger; Pedro M Machado; Philip C Robinson; Paul Sufka; Zachary S Wallace; Jinoos Yazdany; Monique Gore-Massy; Richard A Howard; More A Kodhek; Nadine Lalonde; Laura-Ann Tomasella; John Wallace; Akpabio Akpabio; Deshiré Alpízar-Rodríguez; Richard P Beesley; Francis Berenbaum; Inita Bulina; Eugenia Yupei Chock; Richard Conway; Alí Duarte-García; Eimear Duff; Tamer A Gheita; Elizabeth R Graef; Evelyn Hsieh; Lina El Kibbi; David Fl Liew; Chieh Lo; Michal Nudel; Aman Dev Singh; Jasvinder A Singh; Namrata Singh; Manuel F Ugarte-Gil Journal: RMD Open Date: 2022-09