OUTCOMES OF COVID-2019 IN RENAL TRANSPLANT RECIPIENTS VERSUS CHRONIC HEMODIALYSIS PATIENTS: ANALYSIS OF A REGIONAL COHORT

Introduction: SARS-CoV-2 causing COVID-19 has rapidly spread around the world with the first German cluster emerging in the area around Heinsberg Mortality rates are reported to vary between 1-14% While end-stage renal disease is a putative risk factor for adverse outcomes of COVID-19, the impact of carrying a renal transplant (KTX) versus being on chronic hemodialysis (HD) is not well defined Methods: We describe a cohort of 21 patients on renal replacement therapy (7 KTX and 11 HD treated for COVID-19 plus 3 asymptomatic HD carriers of SARS-CoV-2) in the Heinsberg area Data were collected systematically via the two local dialysis care providers specifically serving the area as well as the local tertiary care hospital and renal transplant center at the University Hospital Aachen All patients were followed for the entire course of the disease over a median of 66 days (40-71 IQR) Medication, comorbidities and clinical outcome were recorded Results: Of the seven KTX patients four were hospitalized with an acute respiratory distress syndrome (ARDS), three of which died;two of fulminant multiorgan failure and one of multiple complications of intensive care medicine after prolonged weaning and viral encephalitis These three patients also developed acute kidney injury requiring renal replacement therapy In all hospitalized KTX recipients MPA was stopped directly upon admission while CNIs were held only as a more severe clinical course ensued Of the 11 HD patients with COVID-19 six were hospitalized Three developed ARDS, two of them died While requirement for hospitalization and duration of viral RNAshedding were similar in KTX versus HD patients, the duration of illness and of hospitalization were longer in the KTX group by 8 and 14 days, respectively Conclusion: COVID-19 has a variable course in renal transplant recipients as well as patients on chronic hemodialysis ranging from (almost) asymptomatic infection to severe ARDS with lethal outcome Patients on renal replacement therapy seem to have a more favorable outcome than patients after kidney transplantation (mortality 18% vs 43% following KTX) Early reduction of immunosuppression did not seem to prevent mortality