Incidence of COVID-19 and Identification of Possible Risk Factors Associated with COVID-19 in Acute Renal Transplant Recipients in Pakistan

Background: Renal transplant recipients are susceptible to increased mortality with COVID-19 infection. There is insufficient data regarding risk factors for COVID-19 disease acquisition. We aimed to identify them here.Material/Methods: We enrolled Pakistani renal transplant recipients from February 10, 2020, to March 18, 2021, and actively tracked their baseline health status, transplant characteristics, comorbidities, immunosuppressive therapies, and post-transplant follow-ups until September 2021. Furthermore, we formulated 2 questionnaires for their compliance assessment with COVID-19-preventive measures. We also identified COVID-19 disease acquisition, symptomatology, and management.Results: Among the 50 enrolled patients, 14 (28%) patients developed COVID-19, which is higher than the incidence ob-served in general Pakistani population (0.55%). Their mean age was 35.38 years +/- 11.69 SD years, and 82% of patients were males. The following factors were independently associated with COVID-19 disease: female gen-der (P value: 0.042), diabetes mellitus (P value: 0.002), anti-thymocyte globulin (ATG) induction (P value: 0.006), in-person follow-ups (P value: 0.000), prolonged immediate and late post-transplant hospital stays (P value: 0.019 and 0.000, respectively), raised post-transplant serum creatinine (P value: 0.019), and COVID-19 protec-tive measures non-compliance (P value: 0.000). Out of 14 infected recipients, 92.85% required symptomatic management and overall mortality was 0%.Conclusions: Female gender, diabetes mellitus, ATG induction, in-person follow-ups, prolonged hospital stays, raised post-transplant serum creatinine, and COVID-19-protective measures non-compliance were associated with the high-er acquisition of SARS-CoV-2 infection. By taking concrete measures against these risk factors, we can contin-ue renal transplants, as overall mortality was lower than in the general Pakistani population (2%).

Automated summary

The study identified risk factors associated with higher acquisition of SARS-CoV-2 infection in renal transplant recipients, including female gender, diabetes mellitus, ATG induction, in-person follow-ups, prolonged hospital stays, raised post-transplant serum creatinine, and non-compliance with COVID-19 protective measures. By addressing these risk factors, renal transplants can continue with lower overall mortality compared to the general Pakistani population.