Clinical Characteristics and Outcomes of 217 Kidney Transplantation Recipients Hospitalized with COVID-19: A Systematic Review

ABSTRACT Immunosuppressed kidney transplant recipients may have increased risk of causing severe disease during hospitalization of COVID-19. We conducted this review for better understanding the clinical characteristics and outcomes of this population. A literature search was undertaken to identify the studies which reported outcomes of kidney transplant recipients hospitalized with COVID-19 by searching MEDLINE, EMBASE, Web of Science and Google Scholar from January 1, 2019 to July 1, 2020. 38 studies reporting 217 KTR hospitalized with COVID-19 were included in the current study. All patients experienced fever, cough or dyspnea before hospitalization. 52.6% of recipients were classified as severe patients. The mortality of overall patients and discharged patients including those discharged alive and dead was 20.3% and 30.8%, respectively. Among discharged patients, 53.3% of those admitted to ICU, 73.3% requiring invasive ventilation and 38.5% receiving non-invasive ventilation died. 47.3% of in-hospital KTR developed AKI. Among the severe patients who developed AKI, 32.1% requiring renal replacement therapy during hospitalization. In conclusion, immunosuppressed kidney transplant recipients hospitalized with COVID-19 are at higher risk of developing severe disease (53.3%) at a relatively young age and have higher mortality (30.8%) and higher prevalence of acute kidney injury (47.3%) compared to the general population with COVDI-19. Keywords: Acute kidney injury; COVID-19; mortality; SARS-CoV-2; systematic review; transplantation