A Systematic Review of COVID-19 and Kidney Transplantation

Viyaasan Mahalingasivam*, Alison Craik, Laurie A. Tomlinson, Long Ge, Liangying Hou, Qi Wang, Kehu Yang, Damian Fogarty, Ciara Keenan

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)
18 Downloads (Pure)

Abstract

Introduction
Kidney transplant recipients are at increased susceptibility to many viral infections leading to justifiable anxiety about the effects of coronavirus disease 2019 (COVID-19).
Methods
We performed literature searches from multiple resources in April and August 2020 for relevant English and Chinese literature. Abstracts were screened, followed by full-text review with data extraction of reports that included at least 20 kidney transplant recipients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and completed outcomes.
Results
Twenty studies had sufficient data, which we have summarized. Studies were predominantly descriptive and came from France, Italy, Spain, Turkey, United Kingdom, and United States. Quality assessment demonstrated limitations in selection of comparison groups and controlling for additional factors. Mortality rates from published studies were variable. Based on early data early from Spain, 46% of patients who developed COVID-19 within 60 days of transplantation died. Acute kidney injury was common, and mycophenolate was discontinued in most patients.
Conclusion
Given the rapid global spread of COVID-19, reliable evidence is needed to inform public health policies. Hospitalized kidney transplant recipients with COVID-19 are at a high risk of death in early reports but interpretation of these data requires caution, as studies were susceptible to period effects. Reassuringly, the quality of observational data is improving. Detailed and comprehensive data collection through linked registries will be necessary to conduct accurate analyses of risk factors for adverse outcomes, not least given the risks of stopping imunosuppression. This report highlights the early mortality excess in transplant recipients but medium- and longer-term outcomes remain uncertain and merit careful investigation.
Original languageEnglish
Pages (from-to)24-45
JournalKidney International Reports
Volume6
Issue number1
DOIs
Publication statusPublished - 02 Nov 2020

Keywords

  • COVID-19;
  • systematic review
  • kidney transplantation;

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