*Purpose: Limited data are available on COVID-19 clinical presentation and outcomes among kidney transplant (KT) recipients.

*Methods: Multicenter Brazilian cohort of KT patients with laboratory-confirmed SARS-CoV-2 infection. Patients were followed for 3 months. In this preliminary report, we included patients added to the database until 19^thSep20 (40 centers, 1,145 patients).

*Results: 68% received deceased donor grafts, 60% were male, the median age was 52 years (IQR 42-60), median time post-KT was 5.7 years (IQR 2.1-11.1), and 94% had comorbidities beyond chronic kidney disease. 12.6% had nosocomial-acquired COVID-19, the main signs/symptoms were fever (64%), cough (51%), dyspnea (36%), myalgia (33%), and diarrhea (29%). Main laboratory abnormalities were lymphopenia (756 cells/mm³, IQR 446-1164), increased C-reactive protein (18.9 mg/dl, IQR 5.5-70.7), and acute kidney injury (AKI) (48%). Ground-glass opacities were the main radiological finding (55%). 68% of patients required hospitalization, 35% intensive care, 28% mechanical ventilation (MV), 26% require dialysis, 9% lost their grafts, and 24% died. Lethality rates were 36% and 82%, respectively, among hospitalized patients and among those who needed MV. Age (years)(HR 1.059), BMI (Kg/m²)(HR 1.052), baseline creatinine (mg/dL)(HR 1.425), delta creatinine (mg/dL) (HR 1.385) and lactic dehydrogenase (LDH)(U/L)(HR 1.001) were risk factors for death.

*Conclusions: Except for the higher incidence of diarrhea, lymphopenia, and AKI, clinical presentation appeared to be similar to that described for immunocompetent patients. A high percentage of patients in this cohort required hospitalization, probably because patients who sought medical care were those with more severe disease. The lethality rate was high and similar to that described in international cohorts. Older patients, obese, those with inferior baseline renal function, and graft dysfunction were at higher death risk. Higher LDH was also associated with death risk, possibly reflecting larger pulmonary injury.

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