Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type – living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification.

Introduction: The coronavirus pandemic has restricted access to health-care services for kidney transplant patients because of concerns of COVID-19 infection. This single-center prospective study was done to assess the feasibility, acceptability, and effectiveness of telemedicine services for regular follow-up of kidney transplant patients as well as for triaging patients for admission. Methods: The study was undertaken during the lockdown period in India from March 23, 2020 to June 30, 2020. A formatted message seeking all relevant information was sent before teleconsultation. WhatsApp/email using smartphones and Electronic Medical Records system were used to provide telemedicine services. At the end of the e-consult, the patient was asked to rate his experience on a scale of 0–10. Results: A total of 296 consults for 122 patients were given. Of these, 239 (80.7%) consults (96 patients) were for domestic patients and 57 (19.3%) consults (26 patients) were for international patients. The mean age of the patients was 43 ± 15 years. The mean patient satisfaction score for e-consults was 9.5 ± 0.7. Four (3.3%) patients were seen for the first time after transplant via teleconsultation. Nine (7.4%) patients were advised admission and the rest were advised follow-up teleconsultation. Among those admitted, 6 (4.9%) were COVID positive and 1 (0.8%) patient died of COVID-19 pneumonia. Conclusions: Telemedicine offers a viable modality for health-care delivery when access to health care is restricted for transplant patients. Our model of telemedicine can be replicated easily without the burden of high cost for infrastructure.

Introduction: Organ donation is defined as an act of giving one or more organs, without compensation, for transplantation to another person the shortage of organ donation remains one of the biggest barriers globally to the organ transplantation process. The state of Haryana has in the recent past grown leaps ahead in terms of medical tourism, but according to recent data by the MOHAN Foundation, Haryana is among the poorest performers in organ donation, more specifically cadaveric organ donation. This study aimed to assess the attitudes and awareness of organ donation in the general population of Haryana and to find out the barrier to the low organ donation numbers in the state. Materials and Methods: This study was a community-based cross-sectional study carried out among the general population of Haryana. A questionnaire was administered to 500 randomly selected people above the age of 18 in the chosen population. The data were coded and analyzed using Microsoft Excel and SPSS software. Results: A large number, 40.6% (203/500), of the participants in the survey were unaware of the term “organ donation.” Only 24.5% (72/293) of participants were able to correctly identify that “organ donation” was possible from both cadavers and living human beings. 98.6% (289/293) of the participants of the survey were unaware of any legislation regarding organ donation. A dismal 27.3% (80/293) of participants were willing to donate their organs after death. Of those unwilling, 60.1% (128/213) reported that they did not want to donate because of their religion. Of those willing to donate, 28.7% (23/80) reported that they would only donate to a person of the same religion. Conclusion: The overall levels of awareness about the organ donation and acute shortage of organ donors in Haryana as well as awareness about the prevalent low rates themselves remain low. There are various religious biases leading to negative attitude toward organ donation.

Background: Renal replacement therapy is the gold standard treatment of end-stage renal disease. Since the number of cases of chronic kidney diseases are increasing exponentially in our country, only live-related transplant is not enough to bridge the gap between disease and their treatment which increased the demand for deceased renal transplant program in our country. Objective: The objective is to study donors and recipients' characteristics for association with survival of patients in deceased renal allograft transplant. Materials and Methods: It is an ambispective observational analysis of 42 deceased donor renal transplants performed in our institute from January 2012 to December 2019. The difference among donors and recipients' characteristics was analyzed for association with the outcome for survival or death of the patient. Statistical analysis was done using SSPS 21.0 software and P value < 0.05 was taken as statistically significant. Results: In association with survival and expired outcomes, donors and recipients age, donors sex, cause of brain death (traumatic/nontraumatic), standard or extended criteria of donor, serum creatinine at the time of death, dialysis vintage period, warm and cold ischemia time, duration of hospital stay had shown no significant association with survival. While donors' urine output at the time of death, recipients sex, previous sensitization of recipients either by previous episodes of blood transfusion or pregnancy, achievement of normal renal function at day 14 of transplant, and tacrolimus level at 1 month of transplant shown significant association with the outcome. Conclusion: Deceased donors' characteristics, mainly urine output at death, recipients characteristic, namely any previous sensitization, achievement of normal renal function at day 14, serum tacrolimus level at 1-month posttransplant have a significant association with survival of deceased renal allograft transplant recipients. Sepsis and severe acidosis were the main complications contributing to mortality.

Introduction: The immunosuppressant regimen after kidney transplantation typically includes initial induction therapy followed by a maintenance regimen. The induction therapy was introduced with the aim of reducing acute rejections. A retrospective study was conducted to compare the outcomes in patients with different modalities of induction. Materials and Methods: This is a hospital-based retrospective study where 148 patients who have undergone live renal allograft transplantation at SCB Medical College and Hospital from March 2012 to February 2019 were included in the study. All cases included were crossmatch negative, ABO-compatible live renal allograft transplantations. All patients received tacrolimus, mycophenolate sodium, and steroids. Induction therapy varied depending on immunological risk and changes in protocol over time. Basiliximab, anti-T-lymphocyte globulin (ATLG), and anti-thymocyte globulin (ATG) were given in 56, 21, and 21 patients, respectively, and no induction therapy in 50 patients. All patients with an acute rise in serum creatinine and without an obvious cause of graft dysfunction were subjected to renal biopsy. The incidence of acute rejection, patient survival, and graft survival was calculated from the follow-up records and compared among patients receiving different induction therapies. Results: In the high-risk category patients, 31%, 20%, and 18.2% of patients (P = 0.6) and in the low risk category, 37%, 27.3%, and 20% of patients (P = 0.6) had acute rejections in basiliximab, ATLG, and ATG group, respectively. The patient survival at 1 year was 79.3%, 70%, and 81.8% in high-risk group patients (P = 0.84) and 88.9%, 81.8%, and 80% in low-risk group patients (P = 0.88) in the basiliximab, ATLG, and ATG groups, respectively. The graft survival at 2 years was 96.6%, 90%, and 90.9% in high-risk group patients (P = 0.32) and 88.9%, 90.9%, and 90% in low-risk group patients (P = 0.65) in the basiliximab, ATLG, and ATG groups, respectively. Conclusion: In the low-risk group, the use of different modalities of induction does not have any advantage over no induction therapy in reducing the incidence of acute rejection, or improving patient and graft survival. In the high-risk group, all the induction therapies used lead to similar outcomes and none show any advantage over the other in terms of statistical significance. However, patients who received ATLG or ATG have an increased incidence of septicemia as compared to basiliximab and no induction group.

Purpose: Hemorrhagic cystitis (HC) which occurs in 9%–31% of recipients after hematopoietic stem cell transplantation (HSCT) is an important cause of morbidity and mortality. Various treatment approaches have been applied for such as conservative treatments (hydration, analgesic agents, antibiotics), intravesical treatments (bladder irrigation, hyaluronic acid, and prostaglandin E), intravenous or intravesical antiviral agents, hyperbaric oxygen, and surgical treatments. Materials and Methods: This retrospective study included two hundred thirty-three children who underwent HSCT in Pediatric Bone Marrow Transplantation unit between April 2010 and June 2017. Results: Ten patients (4.2%) developed HC. The mean age of patients was 12.8 years and the mean duration of the onset of HC was 20 days. Urine and blood BK polyomavirus were positive in nine and four patients, respectively. Six patients received intravesical hyaluronic acid, three patients received intravesical prostaglandin E, three patients received intravenous ganciclovir, two patients received intravenous and/or intravesical cidofovir and hyperbaric oxygen treatment. The mean time of recovery from hematuria was 43 days. This study showed that the BK polyomavirus has an important role in the development of HC in HSCT patients, as in harmony with the literature. HC has been successfully treated in eight patients with supportive measures and/or intravesical hyaluronic acid. Conclusions: BK polyomavirus plays an important role in the development of HC pediatric patients. Intravesical hyaluronic acid, besides supportive measures, was effective for the treatment of HC and hyperbaric oxygen may be reserved for refractory cases.

Background: COVID-19 infected kidney transplant patients need specialist care in tailoring their immunosuppression drugs alongside routine care. Methods and Materials: This is an observational data from a single center of 12 kidney transplant recipients (KTR) who were hospitalized with COVID-19 from April 2020 to November 2020. The demographics, COVID treatment including immunosuppressive drug regimen were reviewed. Their graft function during the stay, at the time of discharge, and 30 days after discharge was also reviewed. Results: Of 12 patients included, 83% were male patients. The median age was 37 years and the median time since transplant was 42 months. Common comorbidities were diabetes (50%), hypertension (50%), and cardiovascular disease (8%). Ninety-two percent had triple immunosuppressive regimen whereas 8% were in steroid-free protocol. Fifty percent had mild COVID, 8% had moderate disease, and 41% has severe COVID which was managed with institution-specified protocol. Steroids dose was increased in all patients. Antimetabolite was uniformly withdrawn in all patients irrespective of disease severity. Acute kidney injury was noted in 50% of patients which recovered to baseline at discharge. Graft function at 2 weeks and 30 days after discharge was stabilized close to their baseline value. Mortality was 8%. Conclusion: Reduction of immunosuppression, especially the withdrawal of antimetabolites, was found to be safe without graft rejection in KTRs.

Context: In India, the majority of brain-dead organ donors are victims of road traffic accidents, thereby making them entities in medicolegal cases (MLC). This places an additional burden and complicates the organ donation process, as an inquest must be conducted by the police station closest to the accident spot before the possibility of organ donation is considered. Following organ retrieval and donation, a postmortem is required before the body is handed back to the police. These procedures cause delays in the organ donation process and subsequently in families receiving the body of their loved ones. The problem is compounded by the fact that there are variations in the inquest and postmortem procedures in different states. Aim: The study aims to comprehensively enumerate the medicolegal protocols followed by the states having an active deceased organ donation program. Design and Methods: A survey, using a structured questionnaire, was conducted among the senior Transplant Coordinators (key stakeholders in the organ donation process) of eight states. Their experiences handling MLC and the state protocols adhered to were captured. Results: It was found that there were differences in protocols followed by the states with respect to medicolegal organ donation cases. Significant variations were observed in the police inquest and postmortem procedures. A need for training of the police personnel in the medicolegal aspects of the organ donation process is evident from the survey responses. Conclusions: The undue delays lead to difficulties in completing the donation and also cause distress among the family members who have said yes to organ donation despite their grief. The study recommends the need for uniformity in protocols to ease pain points in this program. This is of paramount importance in instances of interstate-organ donation cases.

Introduction: Hypertension is common following successful renal transplantation and has adverse effects on cardio-vascular and graft health. Blood pressure (BP) readings obtained during clinical visits can be misleading and ambulatory blood pressure monitoring (ABPM) is a more reliable and accurate non-invasive method of BP monitoring. Aims and Objectives: To compare office BP with ambulatory BP recordings in successful adult kidney transplant recipients (KTRs). Material and Methods: Office BP (OBP) was measured with mercury sphygmomanometer according to standardized procedure as the mean of two readings taken 1 minute apart; thereafter, 24 hour ABPM was done using automated oscillometric device (Meditech device) in 56 KTRs. Results: OBP missed hypertension in 68% of KTRs who had normal OBP (masked phenomenon) and OBP overestimated hypertension in 11% of KTRs with uncontrolled OBP (white coat phenomenon). Thirty-four percent of patients were normal dippers, 32% non-dippers, 25% reverse dippers and 9% were extreme dippers. Conclusions: ABPM is a valuable tool in detecting dipping status, white coat and masked phenomena which are frequent problems among KTRs and should be considered as part of routine management of hypertension in KTRs.

Introduction: Novel coronavirus affects different individuals in different ways, with most people recovering with mild to moderate illness not requiring hospitalization. Liver transplant for end-stage liver disease is a lifesaving procedure, and though living donor liver transplant (LDLT) is a well-planned elective surgery, it was considered a semi-emergency owing to the decompensation of the recipient posing a challenge to the transplant team owing to the situation of the pandemic. The availability of liver grafts from cadaveric donors in India was 0.65 per million population until 2019 as per the National Organ and Tissue Transplant Organization statistics which was sparse and further accentuated, leaving LDLT as the only option during the pandemic. Aim: This study aims to describe our experience and testing protocol for COVID-19 disease for the patients undergoing liver transplant during the pandemic at our hospital, which is a tertiary care referral hospital. Materials and Methods: This was a retrospective study done at AIG Hospitals, Hyderabad, India. Fifty adult patients who underwent LDLT and deceased donor liver transplant from May 2020 to December 2020 were included in the study. Exclusion Criteria: All recipients and donors with reverse transcription polymerase chain reaction (RT-PCR) positive for SARS CoV2; and COVID-19 disease reporting and data system (CO-RADS) score of 4 or 5 on high-resolution computed tomography (HRCT) chest. Results: The mean age of the recipients was 46 years, and the donors was 36 years; the most common indication being acute-on-chronic liver failure with failed medical therapies and the second common being hepatocellular carcinoma. All the 50 recipients were RT-PCR negative for SARS CoV2; 8 out of whom had a CO-RADS score of 3; and 4 out of the 8 were post-COVID-19 infection who had IgG positive and IgM negative; and the other 4 were both IgG and IgM negative, similarly 4 out of 8 donors were IgG positive. Intraoperative and postoperative period was uneventful. None of the donors or recipients were infected with COVID-19 disease during the hospital stay and up to 1 month postoperative. One patient died within 1 month due to sudden cardiac arrest. Conclusion: In our experience, with meticulous testing and proper care, there is a favorable outcome for liver transplant even during the pandemic.

Introduction: Adequate allograft perfusion is the key component of renal-transplant surgeries. This requires meticulous management of volume status in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). Various methods have been tried to unveil the most dependable parameter. So far, central venous pressure (CVP) has been a reliable parameter for guiding fluid therapy. Recently, in the past decade, inferior vena cava (IVC) diameter (IVCD) has emerged as a promising indicator for volume assessment in critically ill patients. However, very limited data are available regarding use of IVC diameter in ESRD patients. This study is an attempt to determine the efficacy of IVC diameter in predicting the volume status of renal-transplant recipients by comparing it with conventional method, CVP. Methods: Enrolling 60 live donor renal-transplant recipients from a single center, the mean IVCD and IVC collapsibility index (IVC-CI) were measured and compared with CVP. IVC measurements were recorded using bedside ultrasonography. CVP was measured using central venous catheter placed in superior vena cava, through a water column on a standardized scale. The data were analyzed using SPSS Version 20. Results: The mean age of the participants was 38.92 ± 10.46 years. The mean CVP was 6.78 ± 2.86 cmH₂O, the mean IVCD was 1.30 ± 0.43 cm, the mean IVC-CI was 24.27% ± 15.45%. Based on Pearson's correlation test, there was no linear correlation between CVP and IVCD as well as CVP and IVC-CI. Conclusion: For the assessment of fluid status and fluid responsiveness in ESRD patients with MHD, ultrasound assessment of IVCD and IVC-CI is not routinely helpful.

Background: ABO-incompatible kidney transplantation is one of the ways to increase the donor pool by as much as 30%–35%. Studies comparing baseline titers have shown conflicting results with respect to graft outcomes. This study attempts to evaluate the outcomes of ABO-incompatible transplant with high and low baseline immunoglobulin G (IgG) isoagglutinin titers to the outcomes of ABO compatible transplant. Materials and Methods: This was a retrospective observational study, in which 954 renal transplant recipients were included in the study. Of these, 873 patients had undergone ABO compatible kidney transplantation. Of the 81 patients who underwent an ABO-incompatible transplantation, 67 belonged to the low titer group (defined as the baseline IgG ≤ 1:64) and 14 belonged to the high titer group (defined as baseline IgG ≥ 1:128). Patients were followed up for a period of 1 year. Laboratory assessments were performed at baseline and at each visit. Graft survival, rejection episodes, patient survival, and infections were assessed on a continuous basis. Graft loss was defined by the need to return to dialysis. Results: Death censored graft survival was 92.3% in the high titer group as compared to 98.2% in ABO compatible group, but this difference was not significant (P = 0.231). Graft survival in the low titer group (96.8%) was comparable to the compatible group (P = 0.328). The proportion of patients who developed biopsy-proven rejections was lower in ABO compatible groups (6.5%) when compared to ABOi high (21.4%) and low titer groups (13.4%), respectively (P = 0.063 and 0.033, respectively). Antibody-mediated rejections were significantly fewer in ABO compatible group (1.8%) versus high titer group (21.4%) and low titer group (11.9%) (P = 0.003 and P < 0.001, respectively). Patient survival was higher in ABOc group (97.9%) as compared to high (92.9%) and low titer (94.0%) groups though the difference did not achieve statistical significance. Most of the deaths were attributed to infections. Conclusion: ABO-incompatible transplantation is an acceptable treatment for those with end-stage renal disease; however, this comes with a caveat of increased risk of acute rejections and infections in patients with baseline titers of 1:128 or higher.

Background: India has a significant backlog in terms of renal transplant waiting lists, and progress of deceased donor transplant is limited by social and cultural hurdles. Newer strategies in living donation are needed. Materials and Methods: A prospective comparative study was conducted at our tertiary hospital over 3 years, between living related donor (LRD) and living unrelated donor (LURD) renal transplant outcomes, chiefly acute rejection and graft dysfunction. Confounding variables and outcome parameters such as mortality, hospital stay >21 days, and complications were recorded for 6 months. Results: LRD (n = 78) and LURD (n = 42) groups differed significantly in median recipient age (25 [22–34] vs. 40 [33–50] years; P < 0.001) and human leukocyte antigen (HLA) mismatches >3 (3/78 [3.8%] vs. 32/78 [76.2%]; P < 0.001, respectively). Yet, there was no significant difference in donor age, gender, immunosuppression, preoperative hemodialysis, nephrectomy time, or warm ischemia time. No significant difference was noted between LRD and LURD in acute rejection rate, graft dysfunction at 1 week and 6 months, mortality, hospital stay >21 days, or complication rate. Among factors predictive for acute rejection, only anastomotic time had a significant association (β coefficient = 0.006 [0.001–0.010]; Pearson's coefficient “r” =0.208; P < 0.01), while for early graft dysfunction, it was only mean donor nephrectomy time in minutes (β coefficient=-0.002 [−0.004–0.000]; Pearson's coefficient “r” = −0.158; P = 0.042). Conclusion: Despite differences in HLA-mismatches and age, LRD and LURD had a similar short-term outcome with respect to acute rejection and graft dysfunction. This is linked to better and standardized immunosuppression available, making it possible to expand the scope of LURD beyond spousal, within the legal and ethical boundaries.

Introduction: Remdesivir has shown broad-spectrum antiviral activity. This drug is approved by the Food and Drug Administration for coronavirus disease 2019 (COVID-19) management. Other than a few case series and case reports, not much information is available on its use in kidney transplant recipients (KTRs). Materials and Methods: We describe our experience of seven KTRs with COVID-19. All the patients were hypoxemic. High-resolution computed tomography (CT) chest was done in all the patients. Injection remdesivir 200 mg on day 1 followed by 100 mg daily was given for a maximum of 5 days irrespective of estimated glomerular filtration rate (eGFR). Observations and Results: Mean age of patients was 46.28 ± 10.41 years and one patient was female. Mean CT severity score was 15. In our study, 2 patients who required mechanical ventilation expired. None of our patient had worsening of acute kidney injury (AKI) or new-onset AKI after institution of remdesivir. Discussion: Optimal management for this patient population remains unknown, therefore, treatment of COVID-19 in KTRs varies from center to center. The studies on remdesivir use in KTRs with COVID-19 are not extensive. Our series does indicate safety of remdesivir in KTRs. Conclusion: We observed that remdesivir can be used in KTRs with COVID-19 with hypoxemia irrespective of eGFR. We suggest that large-scale studies should be done to substantiate these findings.

Background: The understanding of transplant acceptance or rejection derives directly from knowing human leukocyte antigen (HLA) involved in the immune response. The HLA of the major histocompatibility complex contains a numerous family of genes located on the short arm of the chromosome number 6 and divided majorly into two classes, Class I (HLA-A, B, and C) and Class II (HLA-DR, DQ, and DP). The detection and detailed information of these histocompatibility genes are essential for the better outcome of organ transplants. Aims and Objectives: The aim of the present study is to analyze the frequencies of HLA-A, B, and DRB1 in chronic kidney disease (CKD) patients and their prospective donors as well as to see the prevalence of heterogenicity. Materials and Methods: A total of 264 patients diagnosed with CKD and 333 potential donors were studied retrospectively in the present study. All these cases were analyzed for HLA-A, B, and DRB1 loci typing by PCR-SSOP method based on the Luminex platform. Results: We identified 15 different alleles of HLA-A, 29 of HLA-B, and 13 of HLA-DRB1 amongst studied samples. Out of these identified HLA alleles, HLA-A*02, HLA-B*35, and HLA-DRB1*15 were more frequent as compared to others. The results showed significant heterogenicity in the identified HLA-A, B, and DRB1alleles. Conclusion: The result highlights the diversity of HLA-A, B, and DRB1 alleles and is valuable as a reference for organ transplantations. Further, these findings can also guide in better donor selection and hence improved transplant outcome. In addition, this information could be a starting point for the development of an indigenous transplant assay kit.

Context: Optimum main renal artery (RA) length before first branching needed to achieve single lumen during laparoscopic donor nephrectomy (LDN) is not known. Aims: The aim of the study is to identify optimal minimum length of RA before first branching which can be safely harvested as a single lumen in LDN. Settings and Design: This is a single institutional, retrospective study. Materials and Methods: Records of consecutive left LDNs performed at our institute from January 2016 to June 2019 were reviewed. RA length was measured from preoperative computed tomography angiogram. We clipped RA using two Hem-o-lok^® and one titanium clip while maintaining constant mild upward traction. Primary outcome was to identify lowest RA length at which chances of achieving a single lumen were maximum. Secondary outcomes included minimum RA length below which single lumen could not be achieved and incidence of intraoperative vascular complications. Statistical Analyses: Receiver operator characteristic curve was plotted according to donor RA length. Likelihood ratio positive (LR+) was used to identify optimum length of RA above which chances of achieving single lumen were maximum. Results: Four hundred and eighty-eight donors with single RA underwent left LDN during study period. LR +of achieving single lumen after clipping was maximum at 10mm cutoff. Single lumen could not be achieved below 6–7 mm cutoff. There were no vascular complications or re-explorations. Conclusions: Main left RA length ≥10 mm before first branching is most likely to yield single lumen for implantation with our technique.

Chronic kidney disease − mineral bone disorder is a common complication in patients with renal failure. Vascular calcification is the part of this clinical syndrome and progresses over the years. A successful renal transplantation ameliorates the uremic milieu and retards the progression of vascular calcification. In some cases, the vascular calcification is progressive even after transplantation leading to undesirable complications. We describe a case of renal allograft recipient who developed renal allograft dysfunction secondary to his progressive vascular disease. His extensive vessel calcification was missed in routine investigations. This case illustrates the need for dedicated evaluation of vascular calcification in high-risk patients undergoing renal transplantation.

Coronavirus disease-2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported from Wuhan, China, and later became a pandemic. While infection is very common, reinfection with SARS-CoV-2 is rare because immune responses from past infection reduce the risk of reinfection. In this report, we describe the case of a kidney transplant recipient who was reinfected with SARS-CoV-2 after successfully recovering from moderate COVID-19, 6 months ago. The first infection occurred in September 2020 while the reinfection occurred in April 2021. Our case highlights that kidney transplant recipients can be reinfected with COVID-19, and therefore, recovery from a primary infection should not be taken as license to shun COVID-related precautions. The disease severity, clinical course, and outcome of reinfection may be different from the first infection.