2.7 COVID-19 infection and kidney transplantation
Kidney transplant patients are currently at a higher risk of COVID-19
infection and its associated mortality, as these patients have a
spectrum of kidney diseases and comorbidities such as hypertension,
diabetes, obesity that requires kidney transplantation (Cravedi et al.,
2020; Gonzalez and Ciancio, 2020). Hence, kidney transplant surgeons
have been advised to suspend kidney transplantation during this pandemic
due to poor outcomes, especially in high-risk older recipients with
comorbidities. This unfortunate obstacle to such an important
life-saving procedure is due to possible donor to recipient viral
transmission or members of the transplant team serving as vectors of the
SARS-CoV-2. Suspension of kidney transplantation during the pandemic
will have a negative impact on the transplant waiting list, thereby
increasing morbidity and mortality (Abu Jawdeh, 2020). SARS-CoV-2 has a
higher tropism for the kidney, where it has been shown to replicate in
about 30% of COVID-19 patients (Fisher and Carson, 2020). In 12
transplant centers in the United States, Italy, and Spain, Cravedi et
al. (2020) reported a high COVID-19-related mortality and AKI rate in
adult kidney transplant recipients. This observation supports previous
findings in which a very high early mortality (28%) was recorded among
kidney transplant recipients with COVID-19 in the United States compared
to 8-15% mortality of COVID-19 mortality among the general population
(Akalin et al., 2020) and dialysis patients on the waiting list for
kidney transplantation (Hilbrands et al., 2020). The high
COVID-19-related mortality in this group of patients is mainly due to
advanced age and frailty (Hilbrands et al., 2020). In conclusion,
patients who have undergone kidney transplantation have a high
COVID-19-related mortality risk, which are driven by factors such as
immunosuppression therapy, comorbidities, advanced age and frailty.