Background and Aims: Covid first wave caused thousands of CKD patients a great ordeal in India as the nationwide lockdown and stoppage of planned transplant operations continued till the month of June 2020. The covid infection was very severe in CKD patients; much so in patients with failed grafts. As the unlocking process started the transplant programs were also initiated in our institution. This study was done to know how covid-19 had affected the outcome and our understanding of renal transplantation in high-risk recipients.

Method: Total 20 cases of 2nd and 3 cases of 3rd renal transplant and 9 cases of HLA sensitized transplantation were done from June 2020 to October 2021. All had living donors. They were monitored for a period of up to 17 months post-transplant.

Results: 26 patients (81.25%) underwent HLA desentisation according to our hospital protocol. Among the 32 cases 13 (40.6%) had history of covid infection prior to the transplant, 2 of them had severe lung fibrosis requiring prolonged (>2 months) inhalational oxygen post recovery from covid. Only 9 (28.12%) recipients were completely vaccinated against covid-19 prior to their transplantation although all received it by the end of observation period. Graft biopsy done in 16 recipients during observation period revealed ATN in 8 cases, ACR in 3 cases, ABMR in 3 and 1 case each of TMA and ascending pyelonephritis were seen. The average duration of follow-up was of 5.6 months and average mean creatinine at discharge was 1.89. Among the 32 patients we lost 6 (18.75%), all due to severe forms of infection (fungal endocarditis-1, Guillain-Barre syndrome-1, mucormycosis-1, severe re-infection with covid-19 - 2, sepsis - 1.  Incidence of acute gastroenteritis and urinary tract infection was more than our normal institutional average but the patients had lower incidence of respiratory tract infections. Post transplantation 7 (21.8%) had acquired covid 19 infections among them 2 died at 1 month and 6 months post transplantation respectively, rest all recovered uneventfully.  Those who died with covid-19 had the infection twice, both before and after transplantation with a gap of more than 9 months and had received 2 doses of vaccination. Infectious complications were seen more in desensitized patients as expected.

Conclusion: In conclusion transplantation done during covid-19 pandemic and in covid-19 recovered cases were challenging. The pandemic uncovered some rare infections which demanded more attention not only from the nephrologists also from anesthesia, pulmonology and infectious disease physicians. Although this pandemic had a great impact on the whole system, with time our understanding of the covid-19 infection has improved for better.