Clinical Profile and Outcome of Coronavirus Disease-2019 Pneumonia in Kidney Transplant Recipients: A Single-center Study from Western India

Abstract

Coronavirus disease-2019 (COVID-19) has become a public health concern and global threat with high morbidity and mortality among kidney transplant recipients. However, risk factors and manifestations in this group of patients remain poorly understood. We aimed to study the clinical characteristics, laboratory parameters, and disease course of kidney transplant recipients with COVID-19 pneumonia. We enrolled 35 kidney transplant patients with COVID-19 pneumonia from March 2020 to November 2020 and studied their clinical records, laboratory results, radiological characteristics, and outcome. Their mean age was 44.82 ± 11.69 years (range: 17-65). The most common symptom was fever (94.28%) followed by cough (54.28%), fatigue (48.57%), shortness of breath (34.28%), and diarrhea/nausea/vomiting (22.85%). Leukopenia was seen in two patients (20.8%), and three patients had leukocytosis, while 75% of the patients had a white cell count in the normal range. Lymphopenia (3) was seen in 23 patients (79%). All patients had elevated levels of C-reactive protein (CRP) with a range of 6-239.9 mg/L. An increase in serum creatinine from the baseline was seen in 25 patients (71.42%) with a mean of 2.62 mg/dL. Computerized tomography scan of the chest of 30 patients (85.71%) showed typical findings of multifocal ground glass shadows in both lung fields. Injection remdesivir was given in 28 patients (80%), and tocilizumab was given to three patients. Mortality was seen in six patients (17.14%), higher in those with O₂ saturation <95% on admission (odds ratio: 6.29). Patients with kidney transplants display a high risk of mortality. The presence of multiple coexisting comorbidities, hypoxia at the time of admission, and high level of inflammatory markers (lactate dehydrogenase, CRP, D-dimer, and ferritin) is predictive of poorer outcomes.