Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

Background. Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Methods. Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units, who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. Results. At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes or de novo donorspecific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. Conclusions. Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.

Automated summary

This study observed the immunosuppressive treatment of kidney transplant recipients hospitalized during COVID-19 and found that it can be safely minimized. Most patients had at least one immunosuppressive agent withdrawn during the course of treatment, while the dose of steroids remained unchanged for the majority of patients.