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Background Casirivimab-imdevimab is a cocktail of two monoclonal antibodies designed to prevent infection by SARS-CoV-2, the virus that causes COVID-19. Casirivimab-imdevimab has been approved in Japan for treating mild to moderate coronavirus disease (COVID-19); however, to the best of our knowledge, there are no reports of its use after kidney transplantation from a live donor. Everolimus, antineoplastic chemotherapy drug, is expected to be effective in inhibiting the spread of SARS-CoV-2 and preventing its replication, which may facilitate treatment. Here, we report a case of COVID-19 infection following kidney transplantation, that was initially treated with casirivimab-imdevimab and mycophenolate mofetil, but was later changed to everolimus. Case report A 47-year-old man underwent living donor kidney transplantation from his mother in 2017. Immunosuppression therapy was underway through the administration of tacrolimus, mycophenolate mofetil, and methylprednisolone. In early September 2021, he was diagnosed with COVID-19 and was hospitalized on Day 3 (Table 1). On hospitalization, mycophenolate mofetil was discontinued and casirivimab-imdevimab and heparin were started. The patient was started on everolimus on Day 5. The clinical course was successful without rejection (Fig. 1). There was no exacerbation of COVID-19; the patient's serum creatinine levels and renal function had otherwise remained stable. Conclusion We could safely treat a patient with casirivimab-imdevimab after kidney transplantation. It is suggested that casirivimab-imdevimab can prevent COVID-19 from becoming severe and can be administered without worsening renal function. In addition, everolimus may have inhibited the spread of the virus and prevented it from replicating.

Background Coronavirus disease-2019 (COVID-19) infection may become more severe in those who have undergone kidney transplantation than in the general population. False-negative reverse transcription-polymerase chain reaction (RT-PCR) results have been reported for COVID-19 infection.Patients might carry infection even though RT-PCR results are negative. Case report A 65-year-old man with a 19-year history of ABO-incompatible kidney transplantation presented with fever and arthralgia. Although the RT-PCR result was negative, a focal slit glass shadow in the left upper lobe on computed tomography (CT) suggested COVID-19 pneumonia. His symptoms did not improve until after 10 days and CT showed multiple slit-glass shadows in the bilateral lung fields. However, RT-PCR remained negative. The patient was admitted and mycophenolate mofetil was discontinued. Anticoagulants were administered on the 3 rd day of hospitalization. Due to poor oxygenation, the patient was intubated in the intensive care unit on the 5th day, and sivelestat sodium was administered. The patient was extubated on the 12 th day following improvement in oxygenation. There was no exacerbation, and CT showed improvements on the 51 st day. Conclusions We report a case of pneumonia with suspected COVID-19 infection 18 years after living-donor kidney transplantation. If COVID-19 is suspected, infection control and aggressive therapeutic interventions should be undertaken with the possibility of a positive result in mind.

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