Discussion
Post renal transplant patients are hypothetically at a higher risk of acquiring COVID-19 infection due to various reasons, including immunosuppressive medication, steroid therapy, and malnutrition.(6) Elias et al identified obesity, diabetes mellitus, and chronic pulmonary diseases as some of the risk factors in post-renal transplant patients for getting COVID-19 infection.(8) Elhadedy et al. also found that hypertension and Diabetes mellitus were the most common risk factors for COVID-19 infection in this group of patients.(9) The most common risk factors or comorbidity were hypertension, Diabetes mellitus, and chronic pulmonary disease in our patient population. All our patients had undergone kidney transplants years back, and most received the kidney from live-related donors. This contrasted with most of the literature, which states that cadaveric renal transplants and recently transplanted renal recipients were at a higher risk of acquiring COVID-19 infection.(8, 9) We also had a higher number of female patients, which is in contrast to the available literature.(8, 9) Similarities to literature include having very high inflammatory and sepsis markers, including ferritin, C reactive protein, fibrinogen, and D Dimers. Immunosuppressants medications were continued in lower doses, and our patients also received steroids during their ICU stay. Acute kidney injury and the requirement of renal replacement therapy is also common with COVID-19 infection. A study from England reported that 57% of post renal transplant patients with COVID-19 required renal replacement therapy.(10) Elhadedy et al reported that 26% of their patients required hemodialysis. Our patient’s series 26% of this group of patients required renal replacement therapy. 37% of our patients required intubation and invasive ventilation. Elias et al reported that 22% of their patients required invasive ventilation.(8) Banerji et al reported one (14%) out of their 7 patients required invasive ventilation.(10) Available literature describes that post renal transplant patients with COVID-19 infection had higher mortality than the general population, ranging from 14 to 24%.(8, 10) In our case series, mortality was 12.5% as one of our eight patients died from complications of the disease.