A Systematic Review of COVID-19 and Kidney Transplantation

Introduction Kidney transplant recipients are at increased susceptibility to many viral infections leading to justifiable anxiety about the effects of 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 SARS-CoV-2 infection and completed outcomes. Results Twenty studies had sufficient data which we have summarised. Studies were predominantly descriptive and came from France, Italy, Spain, Turkey, UK, and USA. 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. Hospitalised kidney transplant recipients with COVID-19 are at a high risk of death in early reports but interpretation of this 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 immunosuppression. This report highlights the early mortality excess in transplant recipients but medium and longer-term outcomes remain uncertain and merit careful investigation.
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