MO090TRANSPLANT KIDNEY BIOPSY FINDINGS IN COVID-19: A SYSTEMATIC REVIEW
Authors: Wu Henry , Jeyalan Vishnu , Chinnadurai Rajkumar , Ponnusamy Arvind 
Published: May 2021

Abstract

Background and Aims
Patients with transplanted kidneys are more susceptible to COVID-19 infections compared to those with native kidneys because of chronic immunosuppression and co-existing co-morbidities. A wide spectrum of renal pathologies has been reported from renal biopsies taken from patients with native kidneys following COVID-19 presentation. In comparison, biopsy-proven findings in the setting of kidney transplantation and COVID-19 diagnosis are seldom described. Our study aims to review early reported histological findings of transplant kidney biopsies from patients testing positive for COVID-19.

Method
This is a secondary analysis of a larger study (PROSPERO registration number: CRD42020218048) which reviewed the histopathological findings of kidney biopsies in adults with concurrent COVID-19 infection. A systematic literature search was conducted independently by two authors (HW, VJ) through ‘PubMed’, ‘Web of Science’, ‘Embase’ and ‘Medline-ProQuest’ using the following keywords: “COVID-19 AND Kidney Biopsy”, “COVID-19 AND Renal Biopsy”, “SARS-CoV-2 AND Kidney Biopsy” and “SARS-CoV-2 AND Renal Biopsy”. Articles were screened by three authors (HW, VJ, RC) for relevance and duplicates were removed. The study selection process was carried out as per the PRISMA guideline. In this analysis, we included all research articles reporting biopsies in transplanted kidneys in adults over age &gt; 18 who tested positive with COVID-19 following a PCR swab test. We only included articles published in the English language. All relevant articles published before November 1st 2020 were included in this review. Information regarding demographic data, co-morbidities, renal presentation, renal parameters at time of COVID-19 diagnosis, management, need for renal replacement therapy and outcomes were extracted from selected articles.

Results
Our review identified 11 cases reporting transplant kidney biopsies in patients with positive COVID-19 status. These 11 cases were reported from 7 articles, which were either single case reports or part of a case series. Mean age of the reported cases was 43.6 years ± 10.7. Transplant kidney biopsies were taken from 4 female and 7 male patients, where 7 patients were of black ethnicity. The review involved 3 live donor and 6 deceased donor transplanted kidneys, and 2 cases did not report type of kidney transplant received. All of the documented cases presented with acute kidney injury. 9 patients have essential hypertension or hypertension secondary to other co-morbidities. Biopsy findings revealed 2 cases of acute T-cell mediated and antibody mediated rejection, 2 cases of acute tubular injury, 5 cases of either FSGS or collapsing FSGS and 1 report of post-transplant kidney infarction. Acute treatment received involved different regimes. All 11 patients were eventually discharged from hospital, where 2 patients required dialysis following discharge. Table 1 describes data from the extracted cases.

Conclusion
There are multiple histological pathologies observed amongst transplant kidney biopsies taken from patients admitted following COVID-19 diagnosis. Early results suggest aggressive medical treatment to manage inflammation, transplant rejection and co-morbidities such as hypertension may optimize general and renal-specific outcomes. Collation of further cases is required to determine a clearer association between COVID-19 and characteristics demonstrated from transplant kidney biopsies.