Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center.
Identifieur interne : 001115 ( Main/Corpus ); précédent : 001114; suivant : 001116Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center.
Auteurs : Michelle Lubetzky ; Meredith J. Aull ; Rebecca Craig-Schapiro ; John R. Lee ; Jehona Marku-Podvorica ; Thalia Salinas ; Laura Gingras ; Jun B. Lee ; Samuel Sultan ; Rosy Priya Kodiyanplakkal ; Choli Hartono ; Stuart Saal ; Thangamani Muthukumar ; Sandip Kapur ; Manikkam Suthanthiran ; Darshana M. DadhaniaSource :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [ 1460-2385 ] ; 2020.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Allografts (MeSH), Antimalarials (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Coronavirus Infections (complications), Coronavirus Infections (drug therapy), Coronavirus Infections (epidemiology), Enzyme Inhibitors (therapeutic use), Female (MeSH), Graft Rejection (complications), Graft Rejection (epidemiology), Graft Rejection (therapy), Humans (MeSH), Hydroxychloroquine (therapeutic use), Immunosuppression (methods), Immunosuppressive Agents (therapeutic use), Incidence (MeSH), Kidney Transplantation (MeSH), Male (MeSH), Middle Aged (MeSH), Mycophenolic Acid (therapeutic use), New York City (epidemiology), Pandemics (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (drug therapy), Pneumonia, Viral (epidemiology), Retrospective Studies (MeSH), SARS-CoV-2 (MeSH), Transplant Recipients (MeSH).
- MESH :
- chemical , therapeutic use : Antimalarials, Enzyme Inhibitors, Hydroxychloroquine, Immunosuppressive Agents, Mycophenolic Acid.
- geographic , epidemiology : New York City.
- complications : Coronavirus Infections, Graft Rejection, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Graft Rejection, Pneumonia, Viral.
- methods : Immunosuppression.
- therapy : Graft Rejection.
- Adult, Aged, Aged, 80 and over, Allografts, Betacoronavirus, COVID-19, Female, Humans, Incidence, Kidney Transplantation, Male, Middle Aged, Pandemics, Retrospective Studies, SARS-CoV-2, Transplant Recipients.
Abstract
BACKGROUND
Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies.
METHODS
We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate.
RESULTS
Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients.
CONCLUSIONS
Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.
DOI: 10.1093/ndt/gfaa154
PubMed: 32678882
PubMed Central: PMC7454827
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Aull</name><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Craig Schapiro, Rebecca" sort="Craig Schapiro, Rebecca" uniqKey="Craig Schapiro R" first="Rebecca" last="Craig-Schapiro">Rebecca Craig-Schapiro</name><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, John R" sort="Lee, John R" uniqKey="Lee J" first="John R" last="Lee">John R. 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Lee</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Sultan, Samuel" sort="Sultan, Samuel" uniqKey="Sultan S" first="Samuel" last="Sultan">Samuel Sultan</name><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Kodiyanplakkal, Rosy Priya" sort="Kodiyanplakkal, Rosy Priya" uniqKey="Kodiyanplakkal R" first="Rosy Priya" last="Kodiyanplakkal">Rosy Priya Kodiyanplakkal</name><affiliation><nlm:affiliation>Division of Infectious Disease, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Hartono, Choli" sort="Hartono, Choli" uniqKey="Hartono C" first="Choli" last="Hartono">Choli Hartono</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Saal, Stuart" sort="Saal, Stuart" uniqKey="Saal S" first="Stuart" last="Saal">Stuart Saal</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Muthukumar, Thangamani" sort="Muthukumar, Thangamani" uniqKey="Muthukumar T" first="Thangamani" last="Muthukumar">Thangamani Muthukumar</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Kapur, Sandip" sort="Kapur, Sandip" uniqKey="Kapur S" first="Sandip" last="Kapur">Sandip Kapur</name><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Suthanthiran, Manikkam" sort="Suthanthiran, Manikkam" uniqKey="Suthanthiran M" first="Manikkam" last="Suthanthiran">Manikkam Suthanthiran</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Dadhania, Darshana M" sort="Dadhania, Darshana M" uniqKey="Dadhania D" first="Darshana M" last="Dadhania">Darshana M. Dadhania</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32678882</idno><idno type="pmid">32678882</idno><idno type="doi">10.1093/ndt/gfaa154</idno><idno type="pmc">PMC7454827</idno><idno type="wicri:Area/Main/Corpus">001115</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001115</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center.</title><author><name sortKey="Lubetzky, Michelle" sort="Lubetzky, Michelle" uniqKey="Lubetzky M" first="Michelle" last="Lubetzky">Michelle Lubetzky</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Aull, Meredith J" sort="Aull, Meredith J" uniqKey="Aull M" first="Meredith J" last="Aull">Meredith J. Aull</name><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Craig Schapiro, Rebecca" sort="Craig Schapiro, Rebecca" uniqKey="Craig Schapiro R" first="Rebecca" last="Craig-Schapiro">Rebecca Craig-Schapiro</name><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, John R" sort="Lee, John R" uniqKey="Lee J" first="John R" last="Lee">John R. Lee</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Marku Podvorica, Jehona" sort="Marku Podvorica, Jehona" uniqKey="Marku Podvorica J" first="Jehona" last="Marku-Podvorica">Jehona Marku-Podvorica</name><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Salinas, Thalia" sort="Salinas, Thalia" uniqKey="Salinas T" first="Thalia" last="Salinas">Thalia Salinas</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gingras, Laura" sort="Gingras, Laura" uniqKey="Gingras L" first="Laura" last="Gingras">Laura Gingras</name><affiliation><nlm:affiliation>Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Lee, Jun B" sort="Lee, Jun B" uniqKey="Lee J" first="Jun B" last="Lee">Jun B. Lee</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Sultan, Samuel" sort="Sultan, Samuel" uniqKey="Sultan S" first="Samuel" last="Sultan">Samuel Sultan</name><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Kodiyanplakkal, Rosy Priya" sort="Kodiyanplakkal, Rosy Priya" uniqKey="Kodiyanplakkal R" first="Rosy Priya" last="Kodiyanplakkal">Rosy Priya Kodiyanplakkal</name><affiliation><nlm:affiliation>Division of Infectious Disease, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Hartono, Choli" sort="Hartono, Choli" uniqKey="Hartono C" first="Choli" last="Hartono">Choli Hartono</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Saal, Stuart" sort="Saal, Stuart" uniqKey="Saal S" first="Stuart" last="Saal">Stuart Saal</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Muthukumar, Thangamani" sort="Muthukumar, Thangamani" uniqKey="Muthukumar T" first="Thangamani" last="Muthukumar">Thangamani Muthukumar</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Kapur, Sandip" sort="Kapur, Sandip" uniqKey="Kapur S" first="Sandip" last="Kapur">Sandip Kapur</name><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Suthanthiran, Manikkam" sort="Suthanthiran, Manikkam" uniqKey="Suthanthiran M" first="Manikkam" last="Suthanthiran">Manikkam Suthanthiran</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Dadhania, Darshana M" sort="Dadhania, Darshana M" uniqKey="Dadhania D" first="Darshana M" last="Dadhania">Darshana M. Dadhania</name><affiliation><nlm:affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association</title><idno type="eISSN">1460-2385</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Allografts (MeSH)</term><term>Antimalarials (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (drug therapy)</term><term>Coronavirus Infections (epidemiology)</term><term>Enzyme Inhibitors (therapeutic use)</term><term>Female (MeSH)</term><term>Graft Rejection (complications)</term><term>Graft Rejection (epidemiology)</term><term>Graft Rejection (therapy)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Immunosuppression (methods)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Incidence (MeSH)</term><term>Kidney Transplantation (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Mycophenolic Acid (therapeutic use)</term><term>New York City (epidemiology)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (drug therapy)</term><term>Pneumonia, Viral (epidemiology)</term><term>Retrospective Studies (MeSH)</term><term>SARS-CoV-2 (MeSH)</term><term>Transplant Recipients (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antimalarials</term><term>Enzyme Inhibitors</term><term>Hydroxychloroquine</term><term>Immunosuppressive Agents</term><term>Mycophenolic Acid</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>New York City</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Graft Rejection</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term><term>Graft Rejection</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Immunosuppression</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Graft Rejection</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Allografts</term><term>Betacoronavirus</term><term>COVID-19</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Kidney Transplantation</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Retrospective Studies</term><term>SARS-CoV-2</term><term>Transplant Recipients</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32678882</PMID><DateCompleted><Year>2020</Year><Month>08</Month><Day>24</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>18</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1460-2385</ISSN><JournalIssue CitedMedium="Internet"><Volume>35</Volume><Issue>7</Issue><PubDate><Year>2020</Year><Month>07</Month><Day>01</Day></PubDate></JournalIssue><Title>Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association</Title><ISOAbbreviation>Nephrol Dial Transplant</ISOAbbreviation></Journal><ArticleTitle>Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center.</ArticleTitle><Pagination><MedlinePgn>1250-1261</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/ndt/gfaa154</ELocationID><Abstract><AbstractText Label="BACKGROUND">Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies.</AbstractText><AbstractText Label="METHODS">We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate.</AbstractText><AbstractText Label="RESULTS">Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients.</AbstractText><AbstractText Label="CONCLUSIONS">Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.</AbstractText><CopyrightInformation>© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lubetzky</LastName><ForeName>Michelle</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aull</LastName><ForeName>Meredith J</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Craig-Schapiro</LastName><ForeName>Rebecca</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>John R</ForeName><Initials>JR</Initials><AffiliationInfo><Affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marku-Podvorica</LastName><ForeName>Jehona</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Salinas</LastName><ForeName>Thalia</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gingras</LastName><ForeName>Laura</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Jun B</ForeName><Initials>JB</Initials><AffiliationInfo><Affiliation>Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.</Affiliation></AffiliationInfo></Author><Author 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