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Lum E, Bunnapradist S, Multani A, Beaird OE, Carlson M, Gaynor P, Kotton C, Abdalla B, Danovitch G, Kendrick E, Nieves-Borrero K, Pham PT, Yabu J, Schaenman J. Spectrum of Coronavirus Disease 2019 Outcomes in Kidney Transplant Recipients: A Single-Center Experience. Transplant Proc 2020; 52:2654-2658. [PMID: 33041077 PMCID: PMC7832798 DOI: 10.1016/j.transproceed.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE We reviewed the clinical experience of kidney transplant recipients diagnosed with severe acute respiratory syndrome coronavirus 2 infection in order to understand the impact of the current coronavirus disease 2019 (COVID-19) pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30% and 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. PROCEDURES In this single center retrospective observational study, medical records of all kidney transplant recipients at the UCLA Medical Center were reviewed for a diagnosis of COVID-19 by polymerase chain reaction, followed by chart review to determine kidney transplant characteristics and clinical course. MAIN FINDINGS A total of 41 kidney transplant recipients were identified with COVID-19 positive polymerase chain reaction. Recipients had been transplanted for a median of 47 months before diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, black 14.6%), on prednisone, tacrolimus, and mycophenolate mofetil (95.1%, 87.8%, and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea, or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the intensive care unit. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. CONCLUSIONS COVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared with earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.
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Affiliation(s)
- Erik Lum
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Suphamai Bunnapradist
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Ashrit Multani
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California, Los Angeles, California
| | - Omer E Beaird
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California, Los Angeles, California
| | - Margrit Carlson
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California, Los Angeles, California
| | - Pryce Gaynor
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California, Los Angeles, California
| | - Camille Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Basmah Abdalla
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Gabriel Danovitch
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Elizabeth Kendrick
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karid Nieves-Borrero
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Phuong T Pham
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Julie Yabu
- Division of Nephrology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Joanna Schaenman
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California, Los Angeles, California.
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