Clinical course of COVID-19 in a liver transplant recipient on hemodialysis and response to tocilizumab therapy: A case report

Abstract

The novel coronavirus disease 2019 (COVID‐19) is a highly infectious and rapidly spreading disease. There are limited published data on the epidemiology and outcomes of COVID‐19 infection among organ transplant recipients. After initial flulike symptoms, progression to an inflammatory phase may occur, characterized by cytokine release rapidly leading to respiratory and multiorgan failure. We report the clinical course and management of a liver transplant recipient on hemodialysis, who presented with COVID‐19 pneumonia, and despite completing a 5‐day course of hydroxychloroquine, later developed marked inflammatory manifestations with rapid improvement after administration of off‐label, single‐dose tocilizumab. We also highlight the role of lung ultrasonography in early diagnosis of the inflammatory phase of COVID‐19. Future investigation of the effects of immunomodulators among transplant recipients with COVID‐19 infection will be important.

Treatment of COVID-19 atypical pneumonia by early Tocilizumab administration in “non-critically-ill” patients on hemodialysis

“…A recent case report described a patient on HD with COVID-19 who deteriorated quickly, developed ARDS and was treated with Tocilizumab at a later stage as compared to our patients, unfortunately no information on the patient's outcome or response to therapy was given [6]. In agreement with our data, early Tocilizumab administration at day 12 promoted a favorable outcome in a liver transplant recipient on HD [7]. Interestingly, Tocilizumab administration in some transplant patients led to a reduced requirement of O2 therapy and an improvement of lung lesions [4].…”

Use of tocilizumab in kidney transplant recipients with COVID-19

“…Considering that the acute respiratory distress syndrome (ARDS) that occurs in some patients throughout COVID‐19 is a consequence of an inflammatory response, tocilizumab appears as a reasonable drug to target the presumable cytokine storm triggered by the virus. Preliminary data in the general population 14‐17 and transplant patients 18‐20 show promising results.…”

Varied clinical presentation and outcome of SARS‐CoV‐2 infection in liver transplant recipients: Initial experience at a single center in Madrid, Spain

“…There is a report of a LT recipient with perioperative infection, 3 two cases during follow-up in China, 4,5 3 cases from Lombardy, 6 6 cases from Madrid, 7 9 from an International Registry, 8 24 from a survey in Italy, 9 and 3 more in the United States. [10][11][12] Therefore, we aimed at presenting our preliminary experience involving COVID-19 in the LT population during the first 2 months of this pandemic crisis in Madrid.…”