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?:abstract
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INTRODUCTION: COVID-19 presents a special challenge to the kidney transplant population METHODS: A systematic review of articles that examined COVID-19 in kidney transplant recipients was performed Patients\' demographics, clinical, laboratory and radiological presentations, immunosuppression modification, and COVID-19 specific management were abstracted and analyzed COVID-19 severity was classified into mild, moderate, and severe Disease outcome was classified by whether the patient was discharged, still hospitalized, or died RESULTS: 44 articles reporting individual data and 13 articles reporting aggregated data on 149 and 561 kidney transplant recipients respectively with COVID-19 from Asia, Europe and America fulfilled all inclusion and exclusion criteria Among studies reporting case specific data, 76% of cases had severe disease Compared to patients with mild/moderate disease, patients with severe disease had higher CRP, LDH, Ferritin, D-dimer and were more likely to have bilateral lung involvement at presentation and longer time since transplantation (P<0 05 for all) Recipients\' age, gender and comorbidities did not impact disease severity Patients with severe disease had a more aggressive CNI reduction and more antiviral medications utilization Outcome was reported on 145 cases, of those 34 (23%) died all with severe disease Longer duration from transplant to disease diagnosis, hypoxia and higher LDH were associated with mortality (P<0 05) Different immunosuppression reduction strategies, high dose parenteral corticosteroids use and various antiviral combinations did not demonstrate survival advantage Similar finding was observed for studies reporting aggregated data CONCLUSION: COVID-19 in kidney transplant patients is associated with high rate of disease severity and fatality Higher LDH and longer time since transplantation predicted both disease severity and mortality None of the COVID-19 specific treatment correlated with, or improved disease outcome in kidney transplant recipients
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