Outcomes of COVID-19 in Kidney Transplant Recipients: The Sri Lankan Experience

Coronavirus disease 2019 (COVID-19) causes severe illness in the immunocompromised. This study aimed to describe the severity and outcomes of kidney transplant recipients (KTRs) treated for COVID-19 during the first 16 months of the pandemic in Sri Lanka. We conducted a cross-sectional survey of all nephrology centers in Sri Lanka using a self-administered electronic data collection sheet. All practicing nephrologists were invited. KTRs who had been treated/were under treatment for COVID-19 between March 1, 2020 and June 30, 2021 were included. Data on patient demographics, management practices, and outcomes were collected. Outcomes included graft loss, requirement of kidney replacement therapy (KRT), duration of hospital stay, highest level of treatment setting, highest level of respiratory support, and mortality. Fifteen nephrologists (12 centers) responded with data regarding 58 KTRs with COVID-19, 10 of whom were receiving ongoing treatment; 47/58 (81%) were male. Forty (69%) were between 30 and 59 years of age and 15 (25.9%) were aged 60 years or above. Fourteen (24.1%) were within 1 year of transplantation. Fifty-three (91.4%) were on triple immunosuppression. Antiproliferative was reduced/withheld in 89.1% and calcineurin inhibitor was reduced/withheld in 42.1%. Overall mortality was 16/48 (33.3%). Seventeen (29.3%) required intensive care. Six (10.3%) received noninvasive ventilation, and 11 (19.0%) received invasive ventilation. Ten of the ventilated patients died. Six needed acute KRT, five of whom died. One patient survived with a loss of graft. There was no association between modifications to the immunosuppression and outcomes. COVID-19 causes poor outcomes and severe illness in KTRs. Special preventive and therapeutic strategies are urgently required.