*Purpose: The current pandemic has created uncertainty surrounding the transmission of COVID-19. It was recently published that in the general population, household contacts have a 53% rate of secondary infection from index patient (Grijalva et al. (2020). MMWR, 69(44), 1631.). Our experience was reviewed in an effort to understand transmission in the immunosuppressed population. The primary objective was to evaluate the effect of recent induction upon COVID-19 transmission to contacts.

*Methods: A retrospective review of adult recipients with COVID-19 detected by PCR within one year of pancreas and kidney transplant was conducted. These patients were interviewed regarding the timeline of their symptoms and the symptoms and testing of household and close contacts.

*Results: 9 patients were identified: 8 Kidney and 1 Kidney/panc. All were primary transplants, except one with a prior lung transplant 2 years earlier, 33.3% were Caucasian, 33.3% Black, 22.2% Asian, 11.1% Hispanic, 55.6% female, 66.7% deceased donor, BMI ranged from 23.1-31.9 and age ranged from 46-68. 66.6% were tested due to symptoms. There were no recipient deaths, graft loss, rejection or decreased graft function resulting from COVID-19. Induction immunosuppression consisted of thymoglobulin (5.2-6.4mg/kg) and 3 dose methylprednisolone. The kidney after lung received 2 mg/kg thymoglobulin. All recipients had tacrolimus/MMF maintenance. Of these recipients, 5 had a history of infection post-transplant, 2 others had concurrent infections with COVID-19. 22.2% had a history of steroid treated rejection prior to diagnosis. The time to diagnosis of COVID-19 ranged from 2 to 12 months post-transplant. All 9 recipients were the index case in their household as far as could be determined, as there were no household contacts reporting symptoms or positive tests prior to the recipient. The recipients had a total of 20 household contacts, 3 (15%) tested positive, 8 (40%) asymptomatic and tested negative, 1 (5%) developed cough but tested negative and 8 (40%) asymptomatic and not tested. In addition to household contacts there were 7 people identified as close contacts; 1 close contact was the likely source of COVID-19 to a recipient, 2 that did contract COVID-19 after recipient exposure and 4 tested negative. One recipient appeared to transmit COVID-19 to 3 contacts, 1 of whom he lived with and 2 other close contacts. There was no indication that the asymptomatic recipients transmitted COVID-19 to any contacts.

*Conclusions: We found no evidence that pancreas and kidney recipients contracting COVID-19 within the first year after transplant had a higher rate of household/close contact transmission than the general population. The recipients were encouraged to wear masks and minimize contact with others. This study suggests that in a very limited sample size, the risk to family members of COVID-19 PCR positive recipients does not appear greater than the general population. Precautionary distancing and barrier measures should be used.

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