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.