The pattern, pharmacotherapy course, drug-drug interactions, and clinical outcome of COVID-19 in kidney transplant patients at a referral transplantation hospital in Iran: A retrospective, observational study

Kidney transplant recipients are at higher risk of developing coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the pattern, pharmacotherapy, drug interactions, and clinical outcome of COVID-19 in kidney transplant recipients at a referral center in Iran. This retrospective, observational study was conducted in Abu Ali Sina Organ transplantation center in Shiraz, Iran. All adult kidney transplant patients diagnosed with COVID-19 and hospitalized for at least 48 hours were included. Required data were collected by reviewing medical charts and health information system of patients at hospital. Potential drug-drug interactions were identified using Lexi-Interact online as well as the Liverpool interactions online website. A total of 108 patients were included. Fever, cough, and shortness of breath were the most common clinical symptoms. About three-fourth (74%) of patients had non-severe COVID-19. Remdesivir was the most widely used antiviral agent. mTOR inhibitors and anti-metabolites were either dose reduced or discontinued in 100% and 80.2% of cases, respectively. Age (odds ratio [OR] = 1.06, 95% [Cl] = 1.02-1.09), calcineurin inhibitor adjustment (OR = 0.26, 95% Cl = 0.09-0.75), baseline white blood cell count (OR = 1.13, 95% Cl = 1.01-1.28), baseline serum lactate dehydrogenase level (OR = 1.32, 95% Cl = 1.03-1.69), administration of tocilizumab (OR = 0.06, 95% Cl = 0.07-0.54), and the severity of COVID-19 disease (OR = 0.03, 95% Cl = 0.00-0.03) had significant association with mortality. The present investigation found that COVID-19 infection in kidney transplant patients may be severe and require hospitalization and even, critical care.