A Systematic Review of COVID-19 and Kidney Transplantation

Viyaasan Mahalingasivam; Alison Craik; Laurie A Tomlinson; Long Ge; Liangying Hou; Qi Wang; Kehu Yang; Damian G Fogarty; Ciara Keenan

doi:10.1016/j.ekir.2020.10.023

A Systematic Review of COVID-19 and Kidney Transplantation

Kidney Int Rep. 2021 Jan;6(1):24-45. doi: 10.1016/j.ekir.2020.10.023. Epub 2020 Nov 3.

Authors

Viyaasan Mahalingasivam¹, Alison Craik², Laurie A Tomlinson², Long Ge^{3

4}, Liangying Hou^{3

4}, Qi Wang³, Kehu Yang^{3

5}, Damian G Fogarty⁶, Ciara Keenan^{7

8}

Affiliations

¹ Department of Renal Medicine, Barts Health NHS Trust, London, UK.
² Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
³ Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, China.
⁴ Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, China.
⁵ Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China.
⁶ Department of Nephrology, Belfast Health and Social Care Trust, Belfast, UK.
⁷ Campbell UK & Ireland, Queen's University Belfast, Belfast, UK.
⁸ Cochrane Ireland, National University of Ireland Galway, Galway, Ireland.

Abstract

Introduction: Kidney transplant recipients are at increased susceptibility to many viral infections leading to justifiable anxiety about the effects of coronavirus disease 2019 (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 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and completed outcomes.

Results: Twenty studies had sufficient data, which we have summarized. Studies were predominantly descriptive and came from France, Italy, Spain, Turkey, United Kingdom, and United States. 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. Hospitalized kidney transplant recipients with COVID-19 are at a high risk of death in early reports but interpretation of these 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 imunosuppression. This report highlights the early mortality excess in transplant recipients but medium- and longer-term outcomes remain uncertain and merit careful investigation.

Keywords: COVID-19; kidney transplantation; systematic review.