*Purpose: Kidney transplant (KTx) recipients are a unique cohort in regard to SARS-CoV-2 susceptibility and clinical course, owing to their immunosuppressed state and propensity for kidney injury. This study investigated and characterized 53 SARS-CoV-2 positive KTx pts at Northwestern Memorial Hospital (NMH) in the first six months of the SARS-CoV-2 pandemic. We sought to identify risk factors and prognostic factors for severity of clinical disease, specific to this population.

*Methods: This retrospective, single-center study included KTx recipients with a positive SARS-CoV-2 PCR at NMH from Jan. 1, 2020 to June 30, 2020. 53 pts met inclusion criteria. Clinical disease severity was ranked according to the WHO Ordinal Scale for SARS-CoV-2 Clinical Improvement, and the study population was divided into three groups based on disease severity {mild disease (ordinal scale of 0-2): n=11, moderate disease (ordinal scale of 3-4): n=29, severe disease (ordinal scale of 5-8): n=13}. We used a chi-squared analysis and a Welch’s T-test to assess differences.

*Results: Black American pts were overrepresented in the SARS-CoV 2 positive cohort, as compared to rates of KTx at NMH (p=0.025) (Figure 1). Hispanic pts were also overrepresented. In the total pt cohort, prevalence of risk factors are as follows: HTN (100%), diabetes (55%), obesity (42%),age ≥60 years) (34%), and heart disease (26%). The severe clinical disease cohort had statistically elevated rates of advanced age and diabetes. Proteinuria was identified in 42% of pts, significantly higher in the severe disease cohort as compared to mild disease (p=0.05). Enhanced immunosuppression (IS), defined by KTx or rejection episode in the last yr, was only present in 15% of cases, and not correlated with disease severity (Table 1). Fatality rate of this total pt cohort at 90 days post infection was 7.5%.

*Conclusions: This single center experience reports disparity between the representation of racial minorities in the overall transplant pt group, and their representation in the SARS-CoV-2 infected transplant pt group (Figure 1). This finding is consistent with reports of overall of higher representation of Black Americans and Hispanic Americans in total SARS-CoV-2 cases and severity of illness. This study demonstrates risk factors previously correlated with severe disease do apply to the KTx recipient cohort as well. As a potential prognostic indicator of disease severity, these data support further investigation into the use of proteinuria. Importantly, this study reports no evidence of enhanced IS worsening clinical outcomes.

« Back to 2021 American Transplant Congress