A key observational study involving kidney transplant patients with COVID-19 was recently published in Nephrology Dialysis Transplantation (May 2020). A group of multidisciplinary collaborators across the WDOM led by investigators in the Division of Nephrology and Hypertension under the leadership of Dr. Manikkam Suthanthiran, and in the Division of Transplant Surgery under the leadership of Dr. Sandip Kapur, Drs. Michelle Lubetzky, Meredith Aull, and Darshana M. Dadhania explored the best approach to treating kidney transplant patients with COVID-19 in the ambulatory and hospital settings.
The study, which focused on kidney transplant patients with COVID-19 at the NewYork-Presbyterian/Weill Cornell Medical Center, provided a unique opportunity to assess this particular cohort of patients who, to date, have been studied in a limited number of case series with inadequate documentation of the course of the illness. In fact, vital data had been lacking on graft and patient outcomes in kidney transplant recipients and the management of their immunosuppression in the setting of Covid-19.
The study determined two key findings on kidney transplant patients with COVID-19: a structured outpatient evaluation can differentiate kidney transplant recipients who can be successfully managed as outpatients versus those who require hospitalization, and complete cessation of immunosuppression therapy is not necessary (although drug treatment may require adjustment). Taking a multidisciplinary coordinated approach, the investigators elected to continue treating kidney transplant patients with immunosuppressive drugs, but a reduced level. This approach resulted in a reduced rate of hospitalization for those patients. Ultimately, the investigators concluded that both ambulatory evaluation and monitoring is feasible for patients with mild/moderate symptoms and patients can be safely triaged to inpatient or outpatient care.
For patients who required hospitalization, a treatment strategy was pursued that included careful evaluation and judicious reduction in immunosuppressive drugs, rather than complete withdrawal of drug treatment. The strategy also included prompt treatment of secondary bacterial infections.
“Given how quickly the infection spread and rate of increase in the number of individuals diagnosed with COVID-19, it was important to develop a systematic approach for evaluation of patients,” explains Dr. Dadhania. “We hope our approach is useful for identifying individuals who can be safely managed at home, as well as provide guidance on management of immunosuppression of kidney transplant patients with COVID-19.”
Dr. Lubetzky is a Clinical Assistant Professor of Medicine in WDOM’s Division of Nephrology and Hypertension. Dr. Meredith J. Aull is an Associate Professor of Pharmacology Research in Surgery at WCM. Dr. Dadhania is an Associate Professor of Medicine, Division of Nephrology and Hypertension, and serves as the Medical Director, Kidney and Pancreas Transplant Program, Department of Transplantation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Suthanthiran is Chief of the Division of Nephrology & Hypertension, WDOM, and Chief of the Department of Transplantation Medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Kapur is Chief of Transplant Surgery and Director of the Kidney and Pancreas Transplant Program at NewYork-Presbyterian/Weill Cornell Medical Center.