Spectrum of COVID-19 Infections in Renal Transplant Recipients: A Single-Center Case Series

Objective: COVID-19 infection can be mild to devastating in renal transplant recipients. We looked at the clinical course in all the renal transplant recipients who attended our hospital for COVID-19 infection. Study Design: Case series - This was a retrospective observational study of renal transplant recipients infected with varying degrees of COVID-19 infection, who sought care in our hospital. COVID-19 infection was defined as mild, moderate, or severe based on the guidelines issued by the Ministry of Health and Family Welfare, Government of India. Settings and Participants: The study included all renal transplant recipients with a functioning graft, who attended our hospital for COVID-19 infection between July 2020 and January 2022. Their data were obtained from electronic records. Results and Observations: A total of 18 renal transplant recipients sought care at our center for COVID-19 infection. There were 19 episodes of COVID infection in these 18 patients (one reinfection). Seven of these were transplanted at our center and 11 were transplanted elsewhere and were following up at our center. Of the 18 patients, 12 (66.67%) had mild infection, 2 (11.11%) had moderate COVID-19 infection, and 4 (22.22%) had severe or critical disease. Two of the severe cases died with a functioning graft, one had graft loss, and one recovered. Acute kidney injury occurred in 22.22% of cases (n = 4). The most common presenting symptom was fever (77.78%). The most common comorbidity was hypertension. The source of infection was predominantly the community (17/18 patients). The number of renal transplants during the above period at our center was 24. The infection rate and mortality rate among these patients were 29.16% (n = 7) and 42/1000 (n = 1), respectively. Limitations: The study was based on the availability of data in our electronic records. There was no standard immunosuppression protocol followed. The retrospective design and small numbers are added limitations of our study. As we included all renal transplant recipients with COVID-19 infection irrespective of the time and place of transplant, the infection rate and mortality rate could not be computed on all 18 patients using a common denominator. Conclusion: Transplant patients have a variable outcome after COVID-19 infection. There may be an inherent individual susceptibility in addition to risk factors such as immunocompromised state and diabetes.