Coronavirus pneumonia in kidney transplant recipients: current evidence from own clinical experience

Abstract

The course and management of coronavirus infection (CI) in patients with severe comorbidity are extremely important scientific and practical issues in the era of COVID-19. Kidney transplant recipients make up one of the most vulnerable groups for CI-associated adverse outcomes. Considering the presence of comorbidities, the optimal pharmacotherapy regimens for CI and its complications have not yet been worked out for these patients. In this article, we present two clinical observations demonstrating typical manifestations of coronavirus pneumonia (CP) in kidney transplant recipients, the COVID-19 diagnostic and verification algorithm, and the therapeutic options used to achieve a favorable outcome of CP and to prevent fatal complications. Our findings confirm that in kidney transplant recipients CP is linked to increased disease severity with rapid progression of lung damage and a high risk of developing systemic complications, including thrombotic microangiopathy. It is shown that compliance with the current recommendations for a rational combination of antiviral, anti-inflammatory, anticoagulant and basic immunosuppressive agents in this group of patients provides good treatment outcomes and prevents kidney transplant failure. Two adverse outcomes in the observed group were due to associated opportunistic infection. Based on our findings and clinical data, we conclude that preemptive therapy with IL-6 inhibitors or colchicine is an effective therapeutic option in kidney transplant recipients.