Background: Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. Methods: Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. Results: Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p < 0.001), acute kidney injury (44.2% vs. 31.8%; p = 0.009), acute respiratory distress syndrome (18.8% vs. 16%; p = 0.456), and cytokine storm rate (15.9% vs. 10.1%; p = 0.072) were higher in first wave compared to the second wave. These 47 patients died within the first month of COVID-19. Six (1.4%) of the surviving patients lost allografts during treatment. There was no difference in the median serum creatinine clearance of the surviving patients at baseline (52 mL/min [IQR, 47–66]), first- (56 mL/min [IQR, 51–68]), third- (51 mL/min [IQR,48–67]) and sixth-months (52 mL/min [IQR, 48–81]). Development of cytokine storm and posttransplant diabetes mellitus were independent predictors for mortality. Conclusions: Mortality remains a problem in COVID-19. All the deaths occur in the first month of COVID-19. Also, acute kidney injury is common in hospitalized patients, and some of the patients suffer from graft loss after the initial episode.

Background and Objectives: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are characterized by persistent inflammation, malnutrition, and immune dysfunction, all of which contribute to poor outcomes in hemodialysis (HD) patients. The C-reactive protein albumin lymphocyte (CALLY) index has been proposed as a novel biomarker that integrates these mechanisms. This study aimed to evaluate the prognostic value of the CALLY index together with established markers, including the C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) for all-cause mortality in HD patients. Materials and Methods: This retrospective cohort study was conducted on 106 patients undergoing HD. Demographic, clinical, and laboratory parameters were obtained three months after the effects of HD initiation was reviewed. Results: During a median follow-up of 24.5 months, 29 patients (27.3 percent) died. Non-survivors were significantly older (65.3 vs. 52.5 years, p < 0.001), had a higher prevalence of coronary artery disease (31 percent vs. 2.6 percent, p < 0.001), or shorter dialysis duration (14 vs. 27 months, p < 0.001). They also showed lower hemoglobin (9.2 vs. 10.1 g/dL, p = 0.007), creatinine (5.3 vs. 6.3 mg/dL, p = 0.048), and albumin levels (28 vs. 34 g/L, p = 0.001), as well as a higher MLR (0.329 vs. 0.254, p = 0.014). In multivariate analysis, age, CAR, and NLR independently predicted mortality, explaining 83.8% of the variation. ROC analysis identified age and MLR as significant predictors, with MLR showing a high negative predictive value (83.9%). The CALLY index did not demonstrate independent prognostic value. Conclusions: Age, CAR, NLR, and MLR were independent predictors of mortality in HD patients, whereas the CALLY index was not prognostic in this cohort. Among these markers, MLR may be a practical biomarker with strong negative predictive power. Larger prospective studies are needed to validate these findings.

Background and Objectives: Kidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD). An accurate evaluation of donor renal function is critical for living kidney transplantation. This study aimed to assess the impact of donor glomerular filtration rate (GFR) on long-term graft function and survival. Materials and Methods: A retrospective analysis was conducted on 229 donor–recipient pairs who underwent living kidney transplantation at our center. Data on recipient demographics, clinical characteristics, and donor GFR were collected. The outcomes of graft survival were compared based on donor and recipient characteristics. Logistic regression was used to identify the factors influencing graft loss. Results: Mortality was significantly higher in the graft loss group (26% vs. 5.1%, p = 0.001). Graft biopsy was associated with a 24.74-fold increased risk of graft loss (95% CI: 5.387–113.609, p < 0.001). Each 1 mL/min/1.73 m² increase in donor GFR reduced graft loss risk by 0.075% (95% CI: 0.870–0.983, p = 0.013). Donor age, gender, and BMI showed no significant impact on graft survival. Conclusions: A higher donor GFR positively influenced graft survival. However, donor age, gender, and BMI did not significantly affect long-term outcomes. These findings emphasize the importance of thorough donor evaluation to optimize graft survival and recipient outcomes.

Aim: The aim of this study was is to evaluate the effectiveness of the preoperative CRP/albumin ratio on first year mortality after living donor kidney transplantation. Material and Method: This retrospective single-center study includes a total of living kidney transplant recipients’ data who were transplanted between 2011-2020 years. Thirty-six patients who died within the first year after kidney transplantation among 2143 living kidney transplant recipients were included in the study group. Patients who have similar comobordities like mortality group patients who survives than one year after living donor kidney transplantation were enrolled as control group. Results: First year mortality was 1.67% (36/2143) in ten years. Patients in the mortality group were older than the control group (53±13 vs 43±12, p=0.002). The median time spent on dialysis in the mortality group was longer than in the control group (13 months vs 1 month, p=0.029). The median CRP/albumin ratio was higher in the mortality group (2.77 vs 0.85, p=0.001). CRP and CRP/albumin ratio were determined as independent factors affecting mortality in the first year after living donor kidney transplantation as a result of multivariate Cox regression analysis (HR=1.040;95% CI, 1.011-1.069; p=0.004 vs HR=1.148 95% CI, 1.044-1.262; p=0.007, respectively). ROC analysis showed that the CRP/albumin ratio had the power to predict one-year mortality (AUC 0.650 95% CI 0.513-0.787, p=0.041). Kaplan-Meier survival analysis showed a statistically significant difference between the two groups in terms of the cut-off value for CRP/albumin ratio (1.52). Conclusion: This study shows that the CRP/albumin ratio can be used to predict mortality in the first year after living donor kidney transplantation.

Presentation of COVID-19 in renal transplant recipients is similar to that shown in the nonimmunocompromised population; almost all recipients who have this disease present with symptoms of the respiratory system. Acute kidney injury has been found prevalent in transplant recipients with COVID-19. In those with severe COVID-19 disease who transfer to an intensive care unit prevalence of acute kidney injury is more than 50%. The pathophysiological mechanisms of kidney involvement and the type of involvement are unclear. Here, we present a 71-year-old kidney transplant recipient who was admitted to our hospital with pulmonary and renal involvement. A kidney allograft biopsy demonstrated diffuse intrarenal hemorrhage, capillary congestion, and severe acute tubular injury. COVID-19 RNA was detected by real-time polymerase chain reaction from lysed allograft tissues, but no findings of acute or chronic cellular or antibody-mediated rejection were detected. This case indicates that COVID-19 may involve the allograft by causing hemorrhage within the renal parenchymal via direct or indirect pathways.