*Purpose: We aim to systematically review published literature and synthesize the evidence available on therapeutic interventions and clinical outcomes used in the management of COVID-19 among adults’ kidney transplant recipients (KTRs).

*Methods: We searched PubMed, EMBase, the Cochrane registry for systematic reviews, and ClinicalTrials.gov with no language restrictions for articles published from November 1st, 2019 to August 13^th, 2020 on adult KTRs diagnosed with COVID-19 infections in the inpatient and the outpatient settings. We excluded studies of other organ transplants or dual organ transplants. Two independent reviewers assessed articles for study selection and five researchers extracted data. Our primary outcome was to describe the use of therapeutics for the treatment of COVID-19, assess the alterations of the immunosuppressive regimens and the clinical progression of this patient group.

*Results: We identified ninety eligible study (1052 KTRs), of which, 68 (155 KTRs) were case reports or cases series and 23 aggregate-level studies (897 KTRs) of descriptive observational data. Among the 155 patients described in case reports or case series, 44 received intravenous steroids while 55% continued their oral maintenance steroid doses. Aminoquinolines, azithromycin, antivirals, tocilizumab were used for 100, 64, 38, 24 KTRs respectively. Acute kidney injury (AKI) occurred in 56.6% , of whom 15 KTRs required renal replacement therapy (RRT). Twenty-five patients were admitted to intensive care units (ICU) and had a median ICU stay of 10 days,IQR (5-14). The median length of hospital stay was 17 days, IQR (11-29) and death occurred in 22.6% of patients. Antimetabolites were withheld or doses reduced in 90.9%. Among the 897 patients included in the aggregate-level studies, 26.5% died and 35.11% developed AKI, of whom 37 patients required RRT. The incidence of ICU admission in the aggregate-level data was 14.8%. Furthermore, Hydroxychloroquine, azithromycin and tocilizumab were used for 813, 491 and 373 KTRs respectively. Antimetabolites were stopped in 51.2%, calcineurin inhibitors were stopped or doses reduced in 320 KTRs, and 222 patients had an increase in their steroids’ doses.

*Conclusions: Kidney transplant recipients diagnosed with COVID-19 present a vulnerable population with high risk of severe clinical outcomes, including acute kidney injury, ICU admission, and mortality. A careful risk-benefit assessment between the use of antiviral drugs and the interruption of maintenance immunosuppressive agents including steroids is likely to be an important factor in the treatment of COVID-19 in this group.

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