To evaluate the clinical experience in the diagnosis and treatment of COVID-19 in kidney transplant recipients.

The clinical data of 14 kidney transplant recipients diagnosed with severe or critical COVID-19 were retrospectively analyzed. The demography data, clinical manifestations, and test results of laboratory examination, chest CT and metagenomic next-generation sequencing of the 14 kidney transplant recipients were collected. The paired t-test was used to compare the normally distributed measurement data, the paired sample Wilcoxon rank-sum test was used to compare non-normally distributed measurement data. P<0.05 indicates that the difference is statistically significant.

14 recipients had positive results for novel coronavirus nucleic acid detection of throat swabs, and the oxygen saturation levels at rest were all ≤93%. They were diagnosed with severe cases. Among the 14 recipients, case 1 and case 14 had progressive decline in oxygenation index during treatment and developed allograft dysfunction, and both of them required non-invasive ventilator-assisted ventilation as well as dialysis and therefore diagnosed with critical COVID-19. Among the 14 recipients, 10 cases had stable serum creatinine levels during admission; 2 cases had serum creatinine levels that increased by 30% and 50% compared to baseline; 2 cases had progressive increases in serum creatinine levels, which rose to 600 and 700 μmol/L, respectively, and required renal replacement therapy. Chest CT was performed on all recipients upon admission and during treatment. The most common manifestation was multiple subpleural ground-glass opacities in both lungs, with more obvious involvement in the lower lungs and dorsal regions in some recipients. After diagnosis, all recipients received routine electrocardiogram and blood oxygen saturation monitoring, oxygen therapy, symptomatic supportive treatment, antiviral treatment, immunosuppressant adjustment, immunomodulator use, antibacterial drugs therapy, anticoagulant treatment, and other drug treatments. After treatment, the general condition of the 12 recipients diagnosed with severe cases improved compared to before admission. Systemic symptoms and respiratory symptoms were relieved; oxygen saturation levels at rest were all ≥95%; chest CT showed obvious absorption or stabilization. The peripheral blood lymphocyte counts, serum creatinine levels, serum amyloid A levels, C-reactive protein levels, fibrinogen levels, and IL-6 levels showed statistically significant differences between before treatment and before discharge (t=5.74, 3.65, 6.41, 7.86 and 7.40, Z=-2.35, all P<0.05). The two critical cases required regular renal replacement therapy after discharge. The treatment plan was generally well-tolerated by the recipients without any drug withdrawal events due to adverse reactions during treatment. No deaths occurred during the treatment process.

Early administration of antiviral agent is critical for improving the prognosis. Treatment of Paxlovid with Baritinib might still be beneficial for kidney recipient with prolonged course and those already developed severe symptoms.