Kidney recovery post coronavirus infection in hospitalized kidney transplant recipients: A single-center observational study

Background: Kidney transplant recipients (KTR) are at an increased risk of severe disease and death caused by coronavirus-19 infection. There is a paucity of information on the evolution of graft function among hospitalized KTRs who overcome the infection. Methods: The study included adult KTRs at a single transplant institute who were diagnosed with Coronovirus-19 virus and needed hospitalization between March 15, 2020 and January 15, 2021. We analyzed patient demographics, comorbid risk factors, and inpatient clinical course for patients that were able to recover from the infection. Kidney function was analyzed pre-infection, during initial hospitalization and up to 12 months post infection. Results: We identified 48 kidney transplant recipients who were diagnosed with Coronavirus-19 infection during the study period. Eighteen KTRs among these needed hospitalization for symptoms of fever and respiratory distress. Four patients died of Coronavirus-19 infection related complications and were excluded from the study. The 14 remaining patients in the study were predominantly black (78%), with a median time since transplant of 4 years. 64% of the patients developed AKI, with an average peak serum creatinine of 2.64 mg/dl and GFR of 34. The mean serum creatinine and GFR of the group were 2mg/dl and 44 at baseline (prior to infection). This represented an increase in their serum creatinine and GFR of 34% and 29% respectively. The median follow-up post infection was 7.5 months. Serum creatinine and GFR were 1.83 mg/dl and 48 at 3 months, and 2.2 mg/dl and 40 at 6 months post infection. New onset proteinuria was noted in 5 out of the 14 patients (36%), with complete resolution of same in all at 3 months follow up. 75% patients with AKI had complete recovery at 3 month follow-up. The mean baseline GFR of patients who had incomplete recovery was 32. There was only 1 graft loss and this was in a patient who had chronic rejection and had a baseline Cr of 3.8 mg/dl at time of coronavirus-19 infection. Conclusions: AKI is common among KTRs that are hospitalized with Covid-19 infection. Most of these recover, although we noted that patients with baseline lower kidney function (GFR < 32) and existing proteinuria had a lower recovery rate.