Short term outcomes in previously COVID positive kidney transplant recipients in pre-vaccine era

Purpose: To study clinical characteristics and short-term outcomes in kidney transplant recipients who were previously infected with SARS-CoV-2 Methods: In this retrospective, single-center case-series, we identified 5 consecutive kidney transplant recipients (KTRs), who were diagnosed with COVID-19 prior to transplant. Data from electronic medical records were retrieved for demographic, epidemiologic and clinical characteristics. All patients were transplanted after meeting institutional requirements of resolution of COVID-19 infection. Patients were required to have a negative Nasopharyngeal testing by NAT for SARS-CoV-2, 28 days post symptom resolution. For living donor KTRs repeat testing was done at 48 hours prior to transplant date. For deceased donor KTRs, Rapid Nasopharyngeal testing by NAT for SARS-CoV-2 was done at the time of organ offer. Severity of disease was determined by WHO COVID-19 severity classification. Results: The demographics, severity of COVID-19 disease, timing of transplant and post-transplant course of the 5 KTRs with recovered COVID-19 are shown in . Three patients received living donor kidney transplant. Patients were transplanted at a median of 192 days after COVID-19 diagnosis, after complete recovery and documentation of 2 negative SARS-CoV-2 PCRs. Three patients had moderate disease requiring hospitalization. Two patients received ATG for induction, 2 received basiliximab and one living related transplant recipient received steroids for induction. Post-transplant course was uncomplicated, except in one patient (#1), who had bleeding and had to be taken back to surgery on post-operative day 4. SARS-CoV-2 PCR was checked as a part of Per protocol with a positive result. However, patient remained asymptomatic, and tested negative 3 weeks posttransplant. The other four patients developed no symptoms of COVID 19 in their post-transplant course and continue to have excellent graft function at a median of 66 days post-transplant. Conclusions: Potential KTRs with previously resolved COVID 19 disease can be safely transplanted and have favorable short-term post-transplant outcomes. While there could be persistent shedding, re-infection or re-activation of disease, disease course appears to be mild. (Table Presented).