PMID- 35350707 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230916 IS - 2589-5370 (Electronic) IS - 2589-5370 (Linking) VI - 46 DP - 2022 Apr TI - Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study. PG - 101359 LID - 10.1016/j.eclinm.2022.101359 [doi] LID - 101359 AB - BACKGROUND: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). METHODS: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. FINDINGS: Among 372 KT which included 38(10.21%) ABO-incompatible, 12(3.22%) sensitized, 64(17.20%) coexisting donors with COVID-19 history and 20 (5.37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9.1%) with 1(0.26%) death censored graft loss, and 4(1.07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0.14(0.03-0.59); p-value = 0.0071], and use of thymoglobulin use compared to other induction strategies [HR = 0.17(0.03-0.95); p-value = 0.044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1.74-65.83); p-value = 0.011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale