Kidney Transplantation with Modification of Induction Protocol with Infection Control Strategy during COVID-19 Era: Graft and Patients' Outcomes

Document Type : New and original researches in the field of Microbiology.

Authors

Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo-Egypt.

Abstract

Background: With modifications to the induction techniques, policies against COVID-19 are strongly justified in kidney transplants. Objective: This study evaluated the efficacy of induction protocol modification with infection control strategy at the time of transplantation on renal graft and patient's outcome in the first 3-9 months post-renal transplant. Methodology: Retrospective pilot cohort research involved 24 patients who had liver-kidney or live-related kidney transplantation following the use of COVID-19 hospital transplantation management strategy. Total ATG dosage ranged from 3 mg/kg to 6 mg/kg depending on the patient's risk. Results: Post-transplant COVID-19 infection was detected in 16.6% (4 patients). 12.5% (3 individuals) had mild to moderate symptoms. Serum creatinine (2–2.5 mg/dl) was present in 8.3% of the individuals. 12.5% (3 patients) and 4.16% (1 patient) of COVID-19 infections occurred in the eighth or ninth week following kidney transplantation, with negative seroconversion occurring 10–14 days and 4–6 weeks, respectively, after the diagnosis. The COVID-19 result was a full improvement with increased steroids and decreased mycophenolate mofetil (MMF). The mortality was 0%. 95.8% (23 patients) had satisfactory graft function {Serum creatinine was (1.06–0.23 mg/dl)}. 4.16% (1 patient) had a residual blood creatinine level of 2.1 mg/dl after COVID-19 but didn't require dialysis. 4 patients (16.6%) had delayed graft function, and 2 patients (8.3%) with suspected rejection improved in less than a week without graft failure or the need for further treatment. Conclusion: Induction modification combined with effective infection control measures against COVID-19 is linked to positive renal graft and patient outcomes.

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