Kidney Transplant Recipients Facing Acute Kidney Injury Complication COVID-19 Infection

Aims: Acute kidney injury (AKI) was noticed as a common complication of COVID-19 infection, associated with increased intensive care unit (ICU) admissions and mortality. Not surprisingly, Kidney transplant recipients appeared to be at higher risk either for severe COVID-19 infection but also for AKI, due to coexisting conditions and chronic immunosuppression.

Study Design: This is a monocentric retrospective descriptive study.

Place and Duration of Study: The study took place in the nephrology, dialysis and renal transplantation unit and anesthesiology and reanimation department of CHU IBN ROCHD, in Casablanca, between March 2020 and September 2021.

Methodology: The inclusion criteria were: all kidney transplant recipients, who were hospitalized in the nephrology and/or the reanimation departments, at the IBN ROCHD CHU in Casablanca, MOROCCO, who tested positive by PCR for COVID-19 and who developed acute renal failure AKI during their follow up. The study took place between 03/2020 and 09/2021 (i.e. 18 months).

The definition and staging of AKI was based on the KDIGO criteria. Total recovery was defined as the return to baseline of renal graft function. In our study, we excluded patients who had a suspicion of COVID-19 infection without PCR positivity, an estimated glomerular filtration rate (eGFR) lower than15 ml/min/1.73 m2 before admission, and who did not complete at least 1 year of follow-up after kidney transplant.

Results: Thrithy-five of them tested positive for COVID-19. Among them, 65,71% (n=23) developed acute renal failure. Fifteen were men (65.7%) and 8 were women (34,3%). The mean age was 45.77 years with extremes from 25 to 68 years. The most common comorbidity found was arterial hypertension with a 28.57% rate. The median time between kidney transplant and COVID-19 infection diagnosis was 8.82 years (IQR 27-87 months). All patients presented fever, and 15 presented cough, myalgia and dyspnea were noted in 19 of the 23 patients. All of them presented radiological signs on thoracic CT, estimating lesions suggestive of COVID-19 from 10 to 80% of the lungs. Nineteen patients (54;28%) needed to be admitted to an intensive care unit, during hospitalization or during their stay. Seven patients (30.4%) required conventional hemodialysis sessions. All patients received intravenous perfusion of either dexamethasone or methylprednisolone and most commonly an increased dose of the corticosteroids already prescribed; for a period of 7 to 10 days. Immunosuppressive therapy was decreased in 80% of patients. The average length of stay in the intensive care unit was 7 days [3 to 31 days]. Complete remission of the graft function was obtained in 60.8%, while 8.7% returned permanently to hemodialysis. The mortality rate was 30.4%.

Conclusion: Kidney transplant recipients are at higher risk of developing severe COVID-19 infection due to chronic immunosuppression and comorbidities. To this, the rate of acute kidney injury is increased leading to higher rates of admission in intensive care units and mortality.