Immunosuppressive therapy maintenance in a kidney transplant recipient with SARS-CoV-2 pneumonia: A case report

Abstract

Am J Transplant. 2020;00:1-3. | 1 amjtransplant.com | INTRODUC TI ONThe novel coronavirus outbreak has startled the world due to its widespread diffusion and socioeconomic burden. Kidney transplant recipients (KTRs) are perceived to be at high risk of infection, and immunosuppressive therapy management during this global emergency can be a challenge. Herein, we report the case of a KTR who developed SARS-CoV-2 pneumonia and recovered in 15 days while continuing administration of his usual immunosuppressive treatment. | C A S E REP ORTThe patient is a 32-year-old man who underwent kidney transplantation in September 2017 from a deceased donor; ESRD etiology was unknown. Prior to admission, February 3, 2020, his most recently measured creatinine level was 1.9 mg/dL (eGFR 46 mL/min/1.73 m 2 ).Immunosuppressive therapy consisted in tacrolimus (trough levels 6-8 ng/mL), mycophenolic acid (360 mg BID), and prednisone (5 mg).Induction therapy included ATG and basiliximab.Previous medical history was irrelevant except for hypertension and pericarditis treated with colchicine in February, 2017.On March 12, 2020, the patient was admitted to our emergency room after a fever lasting 3 days, dyspnea and non-productive cough, unsuccessfully treated with amoxicillin-clavulanate 1 g TID.Physical evaluation was normal: body temperature was 38°C and oxygen saturation was 97% in ambient air, blood pressure was 130/70 mm Hg, and respiratory rate was 25 breaths per minute.Laboratory results demonstrated a low percentage of lymphocytes (17.8%), absolute and relative monocytosis (1000/mmc; 16.7%), C-reactive protein (CRP) elevation (47.9 mg/L), and slightly elevated levels of procalcitonin (PCT) (0.33 µg/L). Renal function impairment was observed (creatinine 2.6 mg/dL, eGFR 31 mL/min/1.73 m 2 ).Pneumococcus and Legionella infections were ruled out by negative urinary antigens. Arterial blood gas analysis was suggestive of respiratory alkalosis.Chest X-ray demonstrated diffuse septal thickening in the absence of areas of consolidation.On March 13, nasopharyngeal swab testing was performed and SARS-COV-2 was identified by rRT-PCR (Day 0).

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

“…Although renal dysfunction as reflected by decreased eGFR or increased serum levels of creatinine was not considered in the published reports as a co-morbidity, it is important to recognize that renal dysfunction of kidney transplant recipients with COVID-19 ought to be recognized as such. Nevertheless, numerous reports that we reviewed showed that patients with a decreased eGFR plus other comorbidities 39 , 41 , 43 , 44 , 47 , 48 , 52 , 55 or increased serum levels of creatinine plus other comorbidities 36 , 38 , 40 , 42 , 46 , 53 , 54 still achieved a positive outcome. Interestingly, Sharma et al recently completed a retrospective study in which they compared the clinical outcomes of COVID-19 between solid organ transplant recipients and matched nontransplant patients in their medical center, and they found the need for renal replacement therapy in the organ recipients did not affect the incidence of severe COVID-19 and the rate of short-term death 70 .…”

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

“…The characteristics of included trials were presented in Table 1 . A total of 269 patients from 47 studies [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 [95% CI, 42.49; 59.34], and 49% [95% CI, 0.33, 0.65] patients were female.…”

Different clinical presentations of two renal transplant recipients with coronavirus disease 2019: a case report

“…There are 39 (97.5%) patients received antiviral therapy (including lopinavir, oseltamivir, arbidol, darunavir, interferon and nitazoxanide) and 32 (80%) patients received hydroxychloroquine [14]. Although most cases received immunosuppression reduction, others studies reported patients with immunosuppression maintained and recovered successfully [27][28][29].…”