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24 July 2020: Review Paper

Kidney Transplantation in the Times of COVID-19 – A Literature Review

Ashraf Imam ACDEF** , Sadi A. Abukhalaf ABCEF* , Riham Imam BCD , Samir Abu-Gazala AEF , Hadar Merhav ACD** , Abed Khalaileh ABCEF**

DOI: 10.12659/AOT.925755

Ann Transplant 2020; 25:e925755

Table 2 Characteristics of all available reported kidney transplant recipients infected with COVID-19.

Study; CountryNumberAge; SexYears post-Tx; DonorComorbiditiesClinical presentation; Max TempInitial WBCC, NC, LC (×109/L)Initial CRP (mg/L)Baseline Cr (mg/dL)^Initial Cr (mg/dL)
Banerjee; UK []12 #148;M31; deceasedHTNCough, Fever, SOB; N/AN/AN/A3.96N/A
#267;F1; DBDHTN, DMCough, Fever, SOB, Hypoxia; N/A6, N/A, 0.8831.72.54; AKI
#354;F0.25; deceasedDM, CMV infectionSOB, Hypoxia; N/A11.2, N/A, 0.532912.71; AKI
#465;M1.5; deceasedHTNSOB, Chest pain; N/AN/AN/A2N/A
#569;F0.083; deceasedHTN, DMSOB, Fever, V/D; 39°C9.4, N/A, 0.3N/A1.9N/A
#654;M7; N/AHTN, HHACough, Fever; 38.5°C10, N/A, 4N/A1.62.1; AKI
#745;M2.5; N/AHTNFever, Flu-like symptoms, Cough, SOB, Hypoxia; N/A5.5, N/A, 0.31985.111; AKI
Bartiromo; Italy []3 #136; F25; deceasedSLSCough, Coryza, Fatigue; 36.3°CN/A, High, Normal671.51.77
Chen; China []24 #149; M6; DBDHTNHyporexia, Cough, Fever, SOB; 38.6°C3.4, 2.59, 0.4741.241.89
Gandolfini; Italy []25 #175; M10; deceasedCOPD, HTN, Obesity, CADFever, SOB, Flu-like symptoms; 37.5°C6.5, N/A, 0.81802.12.2
#252; F0.66; DCDHTNFever, SOB, D, Flu-like symptoms; 37.5°C2.5, N/A, 0.111581.32.4; AKI
Guillen; Spain []26 #150; M4; deceasedHTN, PTLD, SPFever, V, Dehydration, Cough, Conjunctivitis, Hypoxia; 38.2°C10.5, N/A, 1.8 but developed lymphopenia51.31.6; AKI
Huang; China []27 #158; M12; N/ANoneCough, Fever, SOB, Hypoxia; 37.6°CN/A but developed lymphopeniaN/AN/AN/A
Ning; China []28 #129; M1.5; LivingHTNFever, Fatigue, Chills, Hyporexia, N/V, Chest tightness, nasal stuffiness, Dizziness, Hematuria; 37.7°C11.4, N/A, 1.5N/AN/A1.1; AKI
Seminari; Italy []29 #150; M4; N/AHTN, DMCough, Fever; 37.5°C3.5, 1.8, 1.2 but developed lymphopenia18.6N/A1.7
Wang; China []30 #149; M2; N/AHTN, DMFever, Respiratory symptoms; N/A7, 6, 0.622.7N/A1.4
Zhang; China []31 #138; M0.5; DCDNoneCough, Fever; 38.9°C4.7, 2.6, 0.66N/A1.1
#264; M4; DCDBladder cancerFever, Anuria, Cough,, SOB, Flu-like symptoms; 38.3°C17.6, 16, 0.5337N/A4.6; AKI
#337; F0.66; DCDHTNCough, Fever; 39°C5.6, 3.9, 0.39.7N/A1.5
#447; M1.2; DCDNoneCough, Fever, Flu-like symptoms; 39.8°C4, 2.3, 0.513.3N/A1.6
#538; M3; DCDHTN, DMCough, Fever, Flu-like symptoms; 39.1°C6.4, 3.2, 0.933.7N/A1.5
Zhu; China []32 #152; M12; LivingNoneFatigue, SOB, Chest tightness and pain, N, Hyporexia, Abd.P, Cough, Fever, Headache, Weight loss; 38.9°C9, 7, 1.13 but developed lymphopenia301.571.62
Arpali; Turkey []37 #128; F0.5; LivingLLSFever, Fatigue, Sore throat, Rhinorrhea; 38°C3.1, N/A,
Billa; USA []38 #144; M7; deceasedNoneSOB; N/A2.32.3; AKI
Fontana; Italy []39 #161; M15; deceasedNMZL, PD, NBFever, Chills; 38°C5.4, 4.2, 1.2 but developed lymphopenia411.51.9
Hsu; USA []40 #139; M3;DCM, DM, HTN, ObesityFever, Headache, Sore throat, Cough, SOB, Fatigue, Myalgia, Dizziness, Chills; 38.8°C2.5, N/A, 0.26710.85
Kates, USA []41 #154; M20; deceasedHTN, DM,Fever, Chills, Fatigue, Cough, SOB, N/V/D; 40°C6.2, N/A, 2 but developed lymphopenia1.93.4; AKI
Johnson; USA []42 #157; M0.66; deceasedNoneFever, Chills, Hyporexia, Abd. bloating, Back pain, Fatigue, Myalgia, SOB, Anorexia, D, Oliguria; 38.2°C1.4, 0.7, 0.323.2;
Kim; Korea []43 #136; M4; LivingNoneFever, Cough, Rhinorrhea, D, Oliguria, Chest discomfort; 38.5°C6.6, 5.4, 0.6461.472
#246; M9; deceasedDMCough; N/A4, 2, 1.32721.85
Fernández-Ruiz; Spain []44 #178; M8.3; N/AHTN, Prostate CAFever, SOB
#273; M1.8; N/AHTN, DMFever, SOB, Cough,
#380; M3.8; N/AHTN, DMSOB, Cough, Myalgia, Hyporexia
#471; F6; N/AHTNFever, SOB, Cough, Sore throat
#571; M30; N/AHTN, DM, CADFever, Abd.P
#676; M14.8; N/AHTN, ObesityFever, Rhinorrhea
#739; M16.8; N/AHTNFever, Myalgia
#865: M6.5; N/AHTN, DM, OSAFever, SOB, Cough
Nair; USA []45 #151; M0.42; deceasedHTN, DM, CADFever, Chills, Cough9.2, N/A, 1.10.88
#237; M7; livingHTN, DMCough, Chills, Nasal congestion, Myalgia5, N/A, 2.41801.93
#363; F11.6; livingHTNFever, Chills, Cough, Myalgia, Headache;9, N/A, 1.2341.2
#430; F3.7; livingHTN, DMFever, Myalgia, Headache, V3.7, N/A, 1.21.5
#556; M20; deceasedHTN, DMFever, Cough, Fatigue4, N/A, 0.33064.8; AKI
#680; M13.8; livingHTN, DM, CADFever, Chills, Fatigue, Myalgia, D5, N/A, 0.2871.9
#745; M3.4; deceasedHTN, DMFever, Cough, Myalgia, D5.2, N/A, 1.1381.74
#868; M11.6; N/AHTN, DMFever, Cough, SOB6.7, N/A, 0.52401.46; AKI
#975; F8.6; livingHTN, CAFever, Cough, SOB, Fatigue6.3, N/A, 0.4501.3
#1057; F11.6; deceasedHTN, DMCough, SOB, Chills, Fatigue11, N/N, 1.42301.6; AKI
Zhu; China []46 #124; MNoneFever; 38°CN/A302.24
#255; MCADCough, SOB, FatiguN/A, N/A, 0.3803.48
#329; MNoneFever, Cough, SOB, Fatigue, D; 38.8°CN/A, N/A, 0.471182.84
#430; MHTNFever, Cough, SOB, Fatigue; 39°CN/A, N/A, 0.6422.36
#550; MHTNFever, Cough, SOB, Fatigue; 38.6°CN/A, N/A, 0.440N
#665; FNoneFever, Cough, SOB, Fatigue, D; 38°CN/A, N/A, 0.740N
#752; MHTN, CADFever, Cough, SOB, Fatigue; 38.9°CN/A, N/A, 154N
#849; MNoneFever, Cough, SOB, Fatigue, D; 39.2°CN/A49N
#959; MHTN, COPDFever, Cough, SOB, Fatigue; 38.4°CN/A, N/A, 0.41005.2; AKI
#1037; FHTNFever, Cough, SOB, Fatigue; 40°CN/A, N/A, 0.2342.14
Banerjee; UK []12 N/AN/AN/AAza, PredNo change in ISMsNoneRecovered, N/A
2032N/A1226Tac, MMF, PredTac, MMF stopped, AbxBothDied after 12d
N/AN/AN/ATac, MMF, PredTac, MMF stopped, Abx, oseltamivirMVAlive but suffers, 7d
N/AN/AN/ATac, MMF, PredMMF stoppedBothAlive but suffers
N/AN/AN/ATac, MMF, PredMMF stopped, Abx, PC, furosemide, Blood transfusionICUAlive but suffers, 7d
N/AN/AN/ATac, MMFMMF stopped, PCNoneAlive but suffers, 11d
1907N/A502Tac, Aza, PredAza stopped, Tac reduced, Pred increased, HDNoneRecovered, 13d
Bartiromo; Italy []3 N/AN/AN/ATac, PredTac stopped, hydroxychloroquine, Abx, lopinavir/ritonavir (for 2 days), darunavir/cobicistatNoneRecovered, 14d
Chen; China []24 N/A57/50N/ATac, MMF, PredISMs stopped, Ribavirin, Abx, IVIG, IVMPICURecovered, 32d
Gandolfini; Italy []25 N/A25/45301Tac, MMF, PredTac, MMF, stopped, Hydroxychloroquine, Abx, Lopinavir/ritonavirNoneDied, 5d
83226/62718Tac, MMF, PredTac, MMF, stopped, Abx, Hydroxychloroquine, Darunavir/cobicistatNoneRecovered, 8d
Guillen; Spain []26 8900N/AN/ATac, Pred, EveTac, Eve stopped, Abx, hydroxychloroquine, Lopinavir/Ritonavir, INF-βBothAlive but suffers, 12d
Huang; China []27 N/AN/AN/AMMF, PredMMF, Pred stopped, Abx, oseltamivir, Lopinavir/ritonavir, IVMPMVDied, 40d
Ning; China []28 N/A20/23 but elevated laterN/AMMF, Pred, CsANo change in ISMs, Abx, lopinavir/ritonavir, IVIGNoneRecovered, 12d
Seminari; Italy []29 N/A14/22167 then 277Tac, MMFNo change in ISMs, AbxNoneRecovered, 13d
Wang; China []30 N/AN/AN/AMMF, Pred, CsANo change in ISMs, INF-α, ribavirin, lopinavir/ritonavir IVMPNoneRecovered, 12d
Zhang; China []31 18566/41193Tac, MMF, PredMMF stopped, Tac reduced, oseltamivirNoneRecovered, 16d
63021/31180MMF, PredISMs stopped, Abx, oseltamivirNoneAlive but suffers, 7d
101570/49160Tac, MMF, PredTac, MMF stopped, oseltamivir, IVIGNoneRecovered, 11d
2257/26235Tac, MMF, PredISMs stopped, oseltamivirNoneRecovered, 19d
19520/21248Tac, MMF, PredNo change in ISMs, oseltamivirNoneRecovered, 7d
Zhu; China []32 N/A30/29 but elevated laterN/ATac, MMF, PredISMs stopped, Abx, IVMP, IVIG, INF-α, GADNoneRecovered, 18d
Arpali; Turkey []37 Tac, PredNo change in ISMs, oseltamivirNoneRecovered, 7d
Billa; USA []38 1100285Tac, MMF, PredTac reduced, IVMP,MVAlive but suffers, 31d
Fontana; Italy []39 NNPred, CsACsA stopped, Pred increased, Abx, Hydroxycloroquine, Tocilizumab, IVIG,NoneRecovered, 22d
Hsu; USA []40 112454/44361Tac, MMF, PredMMF stopped, hydroxychloroquine, remdesivirICURecovered, 15d
Kates, USA []41 34/48Tac, MMF,MMF stopped, Tac reduced, Pred, Abx, chloroquine, hydroxychloroquine,NoneRecovered, 16d
Johnson; USA []42 Tac, MMF,Tac, MMF reduced, Abx, hydroxychloroquine,NoneRecovered, 23d
Kim; Korea []43 35/32Tac, MMF, PredTac, MMF stopped, lopinavir/ritonavir, IVMP, hydroxychloroquineNoneRecovered, 23d
10/14Tac, MMF, PredMMF stopped, hydroxychloroquine, Abx,NoneRecovered, 17d
Fernández-Ruiz; Spain []44 Tac, PredTac reduced, lopinavir/ritonavirNoneDied, 5d
Tac, MMF, PredTac reduced, MMF, Pred stopped, lopinavir/ritonavir, hydroxychloroquine, IVIGNoneAlive but suffers, 23d
Tac, MMF, PredTac reduced, MMF stopped, lopinavir/ritonavir, hydroxychloroquineNoneAlive but suffers, 28d
Tac, MMF, PredTac reduced, MMF, Pred stopped, lopinavir/ritonavir, hydroxychloroquine, IVIG, IVMPNoneDied, 16d
TacTac reduced, hydroxychloroquine, IVIG,NoneAlive but suffers, 9d
MMF, Pred, SrlMMF stopped, hydroxychloroquine, IVMPNoneRecovered, 13d
Tac, Pred, EveTac, Eve stopped, hydroxychloroquine, IVMP, Tocilizumab,NoneAlive but suffers, 16d
Tac, MMF, PredTac, MMF reduced, lopinavir/ritonavir, hydroxychloroquineNoneAlive but suffers, 17d
Nair; USA []45 Tac, MMF, Pred, EveNo change in ISMsNoneRecovered
Tac, MMF, PredMMF stopped, hydroxychloroquine, azithromycinNoneRecovered
Tac, MMFMMF stopped, hydroxychloroquine, azithromycin, AbxNoneRecovered
Tac, MMF, PredMMF stopped, hydroxychloroquine, azithromycin, AbxNoneRecovered
Tac, MMF, PredTac, MMF stopped, hydroxychloroquine, azithromycin, AbxBothDied
Tac, MMFTac, MMF stopped, hydroxychloroquine, azithromycin, Abx, IVMPBothRecovered
Tac, MMF, PredMMF stopped, hydroxychloroquine, azithromycin, Abx, IVMPNoneRecovered
Tac, MMF, PredMMF stopped, hydroxychloroquine, azithromycin, AbxICURecovered
Pred, SrlSrl stopped, hydroxychloroquine, azithromycinBothDied
Tac, MMFMMF stopped, hydroxychloroquine, azithromycin, Abx, PredBothDied
Zhu; China []46 NTac, MMF, PredNo change in ISMs, AvxNoneRecovered, 43d
NTac, MMF, PredMMF stopped, Tac reduced, IVIG, AvxMVRecovered, 48d
NTac, MMF, PredMMF stopped, IVMP, AvxNoneRecovered, 37d
NTac, MMF, PredTac, MMF stopped, IVIG, IVMP, AvxNoneRecovered, 37d
104; N/ATac, MMF, PredTac, MMF stopped, IVIG, IVMP, AvxNoneRecovered, 34d
NTac, MMFTac, MMF stopped, IVIG, IVMP, AvxMVAlive but suffers, 49d
94; N/NTac, MMF, PredTac, MMF stopped, IVIG, IVMP, AvxNoneRecovered, 20d
97; N/ATac, MMFTac, MMF stopped, IVMP, AvxNoneRecovered, 34d
61; N/ACsA, mizoribineISMs stopped, IVIG, IVMP, AvxMVDied, 6d
163; N/ATac, MMF, PredTac, MMF stopped, IVIG, IVMP, AvxNoneRecovered, 31d
* Recovered indicates recovery of clinical symptoms and signs not negative COVID-19 testing;
^ Initial Creatinine (Cr) indicates Cr serum level in mg/dL unit before encountering COVID-19.
ISMs – immunosuppressant medications; Max Temp – maximum temperature; DOI – duration of illness:; ICU – Intensive Care Unit; MV – mechanical ventilation; CRP – C-reactive protein; WBCC – white blood cell count; normal is 3.5–10 (×10/L); NC – neutrophil count, normal is 1.5–8 (×10/L); LC – lymphocyte count, normal is 1–3.5 (×10/L); AKI – acute kidney injury; Aza – azathioprine; MMF – mycophenolate mofetil; Tac – tacrolimus; Pred – prednisone; N/A – not available; DCD – donor after cardiac death; DBD – donor after brain death; Abx – antibiotics; Avx – antivirals; V/D – vomiting/diarrhea; PC – Paracetamol; SLS – Senior-Loken syndrome; LOS – loss of appetite; IVMP – intravenous methylprednisolone; IVIG – intravenous immunoglobin; D – Diarrhea; PTLD – post-transplant lymphoproliferative disease; SP – splenectomy; V – vomiting; Eve – everolimus:; INF-β – interferon beta; CsA – ciclosporin; N/V – nausea/vomiting; INF-α – interferon α; Abd.P – abdominal pain; GAD – glycyrrhizic acid diamine; CMV – cytomegalovirus; HHA – hereditary haemolytic anaemia; HD – hemodialysis; LDH – lactate dehydrogenase; ALT – alanine aminotransferase; AST – aspartate aminotransferase; LLS – lupus-like syndrome; NMZL – nodal marginal zone lymphoma; PD – Parkinson disease; NB – neurogenic bladder; DCM – dilated cardiomyopathy; CAD – coronary artery disease; OSA – obstructive sleep apnea; CA – cancer; Srl – Sirolimus.

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358