Iranian kidney transplant recipients with COVID‐19 infection: Clinical outcomes and cytomegalovirus coinfection

Abstract

Background There is a high risk of COVID‐19 in kidney transplant recipients (KTRs) because of chronic immunosuppression and severe cytomegalovirus (CMV) pneumonitis. Case presentation A case series of 10 KTRs with COVID‐19 in Iran was developed. Participants consisted of two female and eight male patients, aged 46‐68 years old. The data related to clinical laboratory tests, outcomes, diagnosis, and drug treatments were collected. The RT‐PCR confirmed the COVID‐19 infection in KTRs. The assessment of serum biochemical and blood hematological factors showed that there was a strong correlation between COVID‐19 intensity and high serum Cr, BUN, and ALT levels, high CRP concentration, and lower lymphocyte and platelet counts in male KTRs. Ground‐glass opacity (GGO) was the main radiologic pattern visible on both chest radiographs of computed tomography scans. The COVID‐19 and CMV coinfection in KTRs resulted in large‐size kidneys with severe parenchymal echogenicity and hydronephrosis. The combined use of effective antibiotic and antiviral drugs was suitable to prevent COVID‐19 progression in KTRs. Conclusions The coincidence of COVID‐19 and CMV in KTRs may potentially increase the mortality risk of patients. The levels of Cr, BUN, ALT, and CRP as well as lymphocytes count in these patients should be continuously controlled.

The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature

“…Some data suggest that IS may exert “a protective role”, as the cytokine storm is considered to be an important factor in the pathogenesis of the disease. Yet, on the other hand, it is also reasonable to advise a reduction, or a temporary withdrawal, of IS drugs during a severe course of COVID-19 in order to obtain earlier restoration of the host immune system [ 88 , 89 ].…”

Viral coinfections in COVID‐19

“…Thus, continuous monitoring of Cr, BUN, ALT, and CRP levels, as prognostic factors, as well as the lymphocyte count is recommended to be regularly measured in these patients to mitigate the risk of death. 173…”

The Predictive Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio on Intensive Care Unit Admission and Mortality of COVID-19 Patients in Iran

“…The pneumonia was called new coronavirus disease 2019 (COVID- 19) and o cially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the WHO [1,2]. COVID-19 shortly spread throughout the world and due to the considerable impact of COVID-19 on the world's people's health the WHO declared it as a pandemic on 11 March 2020 [3]. Although all ages are susceptible to infected with COVID-19, older patients with underlying diseases predisposed to a several conditions of comorbidity such as severe acute respiratory distress due to diffuse alveolar damage with cellular bromyxoid exudates [4].…”