*Purpose: Renal transplant recipients are at increased susceptibility to many viral infections, including coronavirus disease 2019 (COVID-19). The purpose of this review is to define the effect of COVID-19 infection on Lithuanian patients after kidney transplantation.

*Methods: We enrolled patients who underwent kidney transplantation and were diagnosed with COVID-19 infection before January 24th, 2021. Patients were prospectively monitored. Clinical features, management and outcomes were recorded.

*Results: We report on 53 cases of COVID-19 infection in kidney transplant recipients (median age 51 (range 29-75), 53 % females, from a 661 follow-up patients after renal transplantation) in 4 Lithuanian hospitals. Most common symptoms included febrile fever, cough and dyspnea. 55 % patients required hospitalization. Chest x-ray showed both sided infiltration in 63 % of patients, 55 % required supplemental oxygen, 6.8 % needed mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Immunosuppression was changed to Hydrocortisone in 35 %. Remdesivir was administered to 23 % of hospitalized patients, 30.7 % were treated with Dexamethasone. 31 % were admitted to an intensive care unit (ICU) after an average of 3 days after hospitalization. Even though 27 % of the hospitalized patients required kidney replacement therapy, no patients lost their allografts. Overall mortality was 27 %. At an average of 3.6 months post-diagnosis – 76 % of patients tested positive for anti-spike IgG SARS-CoV-2 antibodies.

*Conclusions: The data of COVID-19 infection in Lithuania was similar to that reported in the general population. A standard treatment and strategy of immunosuppression adjustment was applied, with 27% mortality among kidney transplant recipients hospitalized with COVID-19 infection. 76 % of patients tested positive for anti-spike IgG SARS-CoV-2 antibodies after 3.6 months post-diagnosis.

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