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.