*Purpose: The current pandemic has created uncertainty of induction regimen impact upon severity of COVID-19 disease. Our experience with COVID-19 infection was reviewed to stratify outcomes of infection occurring before or after one year from transplant.

*Methods: All COVID-19 PCR positive pancreas and/or kidney transplant recipients were reviewed for demographics and outcomes.

*Results: 65 recipients were identified: 9 <1 year and 56 >1year post-transplant. There were clinically relevant differences between groups. In the <1 year group 100% received thymoglobulin induction and 2 (22.2%) received steroid rejection treatment 2 and 10 months prior to COVID-19 diagnosis. Of recipients > 1 year from transplant there were no rejection treatments within the year prior. Maintenance immunosuppression was CNI/MMF in 66.1%. Infection <1 year post-transplant resulted in no mortality nor worse outcomes. In fact 3 recipients were asymptomatic (tested for upcoming procedure, known exposure or admission). Mild-moderate symptoms (cough, fever) were the cause for testing in 4, but symptoms were of insufficient severity to warrant admission. All non-hospitalized patients recovered without sequala. 2 patients were hospitalized for COVID-19 disease. One recipient had a prior lung transplant and developed fever and hypoxia. Treatment with MMF reduction, dexamethasone and remdesivir permitted avoidance of intubation and discharge within a week. The other hospitalized patient was asymptomatic at positive test, but developed diarrhea and weight loss 2 weeks after initial diagnosis. Other causes of diarrhea were ruled out and it was concluded that symptoms were COVID-19 related, as PCR remained positive. There were no respiratory symptoms. Infections diagnosed >1 year after transplantation were diagnosed because of symptoms, had a higher rate of hospitalization and death. Due to small sample size, statistical significance of increased severity was not feasible.

*Conclusions: With a limited experience, COVID-19 infection within the first year after transplantation does not appear to have a greater mortality or need for hospitalization after lymphocyte depletion induction contrasted to recipients acquiring COVID-19 greater than a year after transplantation.

« Back to 2021 American Transplant Congress