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Background There is limited current knowledge on feasibility and safety of kidney transplantation in COVID-19 survivors. Methods We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR) confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020 to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative SARS-CoV-2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 days and significant social distancing for 14 days prior to surgery. Results Clinical severity in patients ranged from asymptomatic (n=17, 22.7%), mild(n=36,48%), moderate(n=15,20%) and severe(n=7,9.3%) disease. Median duration between PCR positive to transplant was 60 days (overall) and, increased significantly from asymptomatic, mild, moderate and severe disease (49,57,83,94 days, P-value 0.019) respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow up of 81 (56-117) days without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. Conclusions Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pre-transplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. Till date, this remains the first largest study of kidney transplantation in COVID-19 survivors.Supplemental Visual Abstract; http://links.lww.com/TP/C180.

In vitro pretreatment of islets of Langerhans with deoxyguanosine (dGuo) has been shown to be effective for the prolongation of islet allograft survival in rats. [This study evaluates the effect of pretreatment of islets with dGuo transplanted into CsA-treated recipients.] Transplantation of dGuo-treated islets from Wistar rats into diabetic hooded (PVG) rats resulted in 36% graft survival without immunosuppression (dGuo-group) and 89% islet survival after a short course of cyclosporine was used in recipients (dGuo + CsA group). In contrast, transplantation of untreated islets into rats without immunosuppression (controls) and with CsA (CsA group) immunosuppression resulted in 0 and 56% survival, respectively. The differences in graft survival between dGuo versus control group (P less than 0.001), (dGuo + CsA) versus control group (P less than 0.0001), and CsA versus control group (P less than 0.002) are statistically significant. Donor-strain skin-graft challenge failed to induce rejection of transplanted normoglycemic rats in (dGuo) and (dGuo + CsA) groups. The results indicate that a state of immunologic unresponsiveness may have been induced in the recipients of dGuo-treated islets, and further treatment with CsA synergistically prolongs islet survival in fully mismatched rats.