Introduction: The corticosteroid dosing modulation in renal transplant recipients (RTR) with COVID-19, was not well defined. We aimed to analyze the outcomes, infectious and non-infectious sequelae in RTR with COVID-19 with reference to corticosteroid dosing and the first and second pandemic wave of COVID-19.

Material and methods: This study included the RTR admitted during the two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID 19. The outcomes and predictors of survival at four weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, infectious and non-infectious sequelae with reference to high-dose and standard-dose corticosteroids.

Results: A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in first wave vs 17.5% in second wave, P= 0.23). The use of high-dose steroids was also significantly high in non-survivors (85.8% vs 11.3%, P=0.001). On multivariate analysis, the severity of COVID-19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds for mortality. Amongst survivors, 6-months mortality (17.3% vs 0.5%, P= 0.001), readmission rate (91.3% vs 23.7%, P=0.001), fungal infection (30.4% vs. 2.2% p < 0.001), post-COVID lung sequelae (21.7% vs. 4.4%, P = 0.008) were significantly higher in the high-dose corticosteroid group than the standard-dose group.

Conclusion: The high-dose corticosteroid dosing in the RTRs with COVID-19 was associated with increased infectious, particularly fungal infections, non-infectious sequelae with higher mortality on subsequent follow-up.