POS-959 CLINICAL PROFILE AND OUTCOME OF SARS-CoV2 INFECTION IN RENAL TRANSPLANT RECIPIENTS - A SINGLE CENTRE EXPERIENCE

Abstract

Introduction Kidney transplant recipients (KTR) form a vulnerable population group as they are on chronic immunosuppression and have comorbidities like diabetes. Previous studies have shown increased mortality of renal transplant patients infected with SARS-CoV2 infection compared to the general population. We compared the clinical presentations of renal transplant patients infected with SARS-CoV2 in the first and second wave from a large tertiary care centre of South India. Our study aims to analyze the clinical profile, impact on graft function and outcome of KTR infected with SARS-CoV2 and to find the long term effect of SARS-CoV2 infection in this subset of population. Methods In this prospective observational study all KTR infected with COVID-19 confirmed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included since the beginning of the outbreak. Patients who contracted infection in the first wave (March 2020 - February 2021) were compared with those who were infected in the second wave (March 2021- June 2021). They were followed up until August 2021. Results The study included a total of 129 KTR, of whom 72(55.8%) patients were admitted in the first wave and 57 (44.1%) patients in the second wave. Graft dysfunction was seen in 89 (68.9%) patients. Graft dysfunction was higher in second wave (78.9%) when compared to the first wave (61%) [p=<0.001]. The median age of the study group was higher in first wave (p=0.02). Sixty six (51%) patients had severe disease among the KTR admitted. The disease severity was higher in second wave compared to the first (p=0.03). The second wave was also complicated by post covid rhinocerebral mucormycosis among five of the renal transplant patients who were diabetic. Twenty six (20.1%) KTR died of acute covid infection. Nine patients (12.5%) died in the first wave and 17 (29.3%) patients in the second wave. The mortality was significantly higher in the second wave when compared to the first (p=0.03). Follow up The median duration of follow up was 124 (30-244) days. Seventy four (71.8%) patients were followed up. Fifty one (81%) patients from the first wave and twenty three (40.3%) patients from the second wave were followed up. Twenty patients (19.4%) had persistent graft dysfunction. Eight (7.8%) patients underwent renal allograft biopsy of whom three patients had graft pyelonephritis, three had acute cellular rejection, one patient had antibody mediated rejection and one patient combined acute cellular and antibody mediated rejection. Seven (6.7%) patients died during follow up. Conclusions The mortality, severity of infection and graft dysfunction of KTR infected with SARS-CoV2 were higher in the second wave compared to the first wave. Renal allograft biopsy performed on SARS-CoV 2 infected KTR during follow up showed acute cellular rejection, antibody mediated rejection and graft pyelonephritis. No conflict of interest