**5. Conclusions**

This study reflects the experience with COVID-19 in LTRs during the first two disease waves in Switzerland and describes clinical, laboratory, radiology features and clinic outcomes. Severe disease was shown in two patients, who did not survive. The study highlights the exceptionally high rate of non-pulmonary symptoms in comparison to immunocompetent patients, and suggests that comorbidity as well as elderly and overweight patients have a higher risk of non-favorable outcomes. Laboratory values suggesting

a dismal outcome are elevated CRP and LDH, while liver functions remained normal in all stages of COVID-19 severity. In LTRs, remdesivir and CCP can be considered as treatment options depending on the disease stage. Additionally, in patients with chronic renal insufficiency, remdesivir could be considered using an adapted dosage. The rate of hospitalization in this population is relatively high, several explanations have been discussed above.

**Author Contributions:** R.H. and M.M.S.: patient treatment, concept, design, acquisition and interpretation of data, draft writing, analysis of data. S.P.: patient treatment, acquisition of data, protocol remdesivir in hemodialysis C.S., F.G., I.I.: patient treatment. M.M.S.: supervision of interpretation of study, draft writing and editing. All authors have read and agreed to the published version of the manuscript.

**Funding:** No funding was obtained for this study.

**Institutional Review Board Statement:** Swissethics, No. 2021-00293.

**Informed Consent Statement:** General informed consent available of all patients studied.

**Data Availability Statement:** Not applicable.

**Acknowledgement:** We would like to thank Nicolas Mueller for the infectious disease division for his advice given concerning the treatment of some of our patients.

**Conflicts of Interest:** The authors declare no conflict of interest.

**Limitation of Study:** The main limitation of the study is the single center design and the fairly small sample size, and thus the results may not reflect the true picture of a large cohort. The pharmacological agents used for the treatment of COVID-19 in this cohort were not proven in randomized controlled trials and were used as per institutional guidelines for management of COVID-19 patients.
