Introduction. The pandemic of SARS Cov-19 (COVID-19) has affected millions of individuals and resulted in 3 percent mortality worldwide. Kidney allograft recipients are at increased risk of mortality and morbidity in COVID-19, due to their immunosuppressed and cardiovascular conditions. Methods. This study evaluated the outcome of renal allograft recipients with COVID-19 in a single referral center. Seven thousands, seven hundred and forty one patients with COVID-19 admitted in Firoozgar Hospital from March 2019 to September 2021. Among them 59 were kidney allograft recipients with the age range of 18-76. We reported our outcome as the mortality during hospital stay. Acute kidney injury and severity score were defined based on KDIGO and WHO classification, respectively. Our Therapeutic management included low dose CNI and antimetabolites withdrawal. The selection of steroid dose was related to severity score. Critical and severe patients received methylprednisolone pulse for three consecutive days. Results. Fifty nine renal allograft recipients were included in this study, 38 (64.5%) were male and 21(35.6%) were female. The most frequent comorbidities were diabetes mellitus (52.5%) and hypertension (30%). The mortality rate was 22% (13 out of 59). Forty six (78%) patients were discharged from the hospital with good condition. According to defined WHO classification severity score, 15 (25.4%) had mild, 14 (23.7%) moderate, 17 (28.8%) severe, and 13 (22%) were in a critical situation on admission. Acute kidney injury developed in 13.6% of patients. Univariate analysis showed that Severity score, age, transplant duration, CRP and lymph/neutrophil ratio, LDH, and need for intubation were the major predictive risk factors of mortality (P < 0.05). Conclusion. The mortality rate in hospitalized kidney allograft recipients was 1.5 to 3 fold higher than general population. Those with acute kidney injury need long term follow up for the detection of permanent sequel. As the COVID-19 infection in renal allograft recipients considerably increases the risk of morbidity and mortality, these patients should be monitored closely to prevent poor outcomes.
COVID-19 outcome in kidney allograft recipients, a report of a referral center