High Incidence of Acute Kidney Injury in Kidney Transplant Recipients with COVID-19: A Single-Center Case Series from Tehran

Kidney transplant recipients are among vulnerable individuals with increased risk of developing COVID-19. Long-term immunosuppression and multiple co-morbidities might affect clinical characteristics of COVID-19 in such patients. In this study, we describe clinical presentations and the incidence of Acute Kidney Injury (AKI) in 9 kidney transplant patients with COVID-19.

This retrospective case series was conducted on 9 kidney transplant recipients with COVID-19 who were admitted in Imam Khomeini Hospital Complex during the first wave of the disease in Iran from February 20 to 20th April 2020. The diagnosis of COVID-19 infection was confirmed by either positive results of quantitative RT-PCR on nasopharyngeal swabs or typical findings in chest CT scanning. 

The median age of patients was 51 years and the graft was functional in all cases before COVID-19 infection. Most patients complained of fever (8 cases), followed by cough (7 cases) and shortness of breath (5 cases). Eight cases had lymphopenia, and leukopenia was reported in 4 cases. AKI occurred in 8 cases. The increase in serum creatinine level resolved partially in most cases, but those who required renal replacement therapy had worse prognosis. Those who survived the acute illness are still alive after more than 16 months with functioning graft.

It was shown in our study that similar to general population, fever and respiratory symptoms are presenting features of COVID-19 in kidney transplant recipients. Lymphopenia is more prominent and the course of COVID-19 infection is more likely to be complicated by AKI in such patients.