530 - COVID-19 in kidney transplant recipients: Single-center experience and case-control study

The ePoster content is available to users who are logged in.<br><br>Please log in and then come back here to use this button.

Presenting Author(s)

Anna Hardesty

Resident Physicain
Brown University Internal Medicine Residency
Providence, RI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Aakriti Pandita

Assistant Professor
University of Colorado School of Medicine
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Yiyun Shi

Medicine resident
Warren Alpert Medical School of Brown University
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KV

Kendra Vieira

Research Assistant
Warren Alpert Medical School of Brown University
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ralph Rogers

Assistant Professor of Medicine, Clinician Educator
Warren Alpert Medical School of Brown University
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BM

Basma Merhi

Attending physician
Divisions of Nephrology, the Warren Alpert Medical School of Brown University
providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AO

Adena Osband

Attending physician
Department of Surgery (Transplantation), the Warren Alpert Medical School of Brown University
providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GB

George Bayliss

Attending physician
Divisions of Nephrology, the Warren Alpert Medical School of Brown University
providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RG

Reginald Gohh

Attending physician
Divisions of Nephrology, the Warren Alpert Medical School of Brown University
providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PM

Paul Morrissey

Attending physician
Department of Surgery (Transplantation), the Warren Alpert Medical School of Brown University
providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Curt Beckwith

Associate Professor of Medicine
Alpert Medical School of Brown University/The Miriam Hospital
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Dimitrios Farmakiotis

Assistant Professor, Director of Transplant and Oncology ID
Division of Infectious Diseases, The Warren Alpert Medical School of Brown University
Providence, Rhode Island
Disclosure: Astellas (Grant/Research Support)

Background: Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date.

Methods: We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died.

Results: 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34-65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1-203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2).Table 1

Table 2

Conclusion: Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway.