Outcome of COVID-19 infection in patients with kidney transplant in the first two years of the pandemic – our experience with the use of tocilizumab and monoclonal anti-SARS-CoV-2 antibodies

Abstract

Introduction/Objective Kidney transplant recipients were at higher risk for COVID-19–associated complications and mortality. The goal was to examine the frequency and outcomes of COVID-19 infection among patients under our center’s control, as well as the effects of tocilizumab and anti-SARS-CoV-2 antibodies.

Methods We analyzed a cohort of 220 kidney transplant patients monitored at our center that experienced COVID-19 infection between March 2020 and March 2022.

Results During the two-year-long period, 55 patients contracted COVID-19 (25%). The average age of the infected was 48.38 years. In 24% of patients during COVID-19 infection the immunosuppressive therapy did not change. Because of pneumonia development, 33% of patients have been hospitalized. Of all infected patients, tocilizumab was used in 7% of patients, of whom three died. Anti-SARS-CoV-2 monoclonal antibodies were used in 24% of patients, no fatalities were reported. Antiviral medication (favipiravir) was used in 4% of patients, in one case fatal. Continuous renal replacement therapy / hemodialysis was applied in 5.5% of patients. Out of all infected, 14.5% of patients had a fatal outcome. The cause of death was severe acute respiratory syndrome (50%), cardiac arrest (25%), or multiorgan failure (25%).

Conclusions The therapeutic use of monoclonal antibodies was reliable, with a significant positive effect on achieving a milder clinical form and shorter duration of the disease. The main risk factors for adverse outcomes of COVID-19 infection in kidney transplant recipients were serious comorbidities and late presentation to the transplant center.

Keywords: kidney transplant; COVID-19 infection; anti-SARS-CoV-2 antibodies