VİVEK B KUTE, UMAPATİ HEGDE, PRATİK DAS, ASHİSH SHARMA, MADAN M BAHADUR, KESHAB SİL, SANDEEP GULERİA, PREM P VARMA, TUKARAM JAMALE, HARİ SHANKAR MESHRAM
Experimental and Clinical Transplantation - 2021;19(10):1023-1031
Objectives: There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. Materials and Methods: We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. Results: COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19- positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically signi - ficant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. Conclusions: To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.
