Elsevier

Transplant Immunology

Volume 69, December 2021, 101445
Transplant Immunology

Summary report of seven cases of COVID-19 infection in renal transplant recipients

https://doi.org/10.1016/j.trim.2021.101445Get rights and content

Highlights

  • Renal transplant recipients(RTRs) are at high risk of COVID-19 infection.

  • All patients received at least one antiviral drug.

  • For moderate and severe cases, it is recommended to discontinue immunosuppressive agents and use MP and IVIG for treatment.

  • Individualized treatment is necessary for RTRs with different clinical types of COVID-19 infection.

Abstract

The coronavirus disease 2019 (COVID-19) has swept the world, posing a serious threat to people's lives and health. Several cases of COVID-19 infection in renal transplant recipients (RTRs) have been reported, but the treatment and prognosis have not been fully elucidated. We followed-up with RTRs infected with SARS-CoV2 in our center and classified them as five clinical types—asymptomatic, mild, moderate, severe, and critical. The immunosuppressive agents were not adjusted in asymptomatic carriers and mild patients, the former was mainly treated by isolation, and the latter was treated by low-dose intravenous immunoglobulin (IVIG) to enhance immunity. For moderate or severe patients, the immunosuppressive agents were largely reduced or even interrupted, low-dose IVIG was adopted, and low-dose methylprednisolone (MP) was used to inhibit inflammation and rejection. Immunosuppressants were discontinued early in critical patients; IVIG, high-dose MP, and antibiotics were used. Meanwhile, all patients received at least one antiviral drugs. After aggressive treatment, three patients developed acute kidney injury, and two showed reversal, while the remaining one lost the allograft kidney; one patient died, while other patients were discharged. For different clinical types of RTRs infected with COVID-19, personalized therapies were essential, Meanwhile, patients with COVID-19 infection may have different outcomes due to their different clinical manifestations.

Keywords

Management
COVID-19
Renal transplant
SARS-CoV-2
Treatment

Abbreviations

ADPKD
autosomal dominant polycystic kidney disease
AKI
acute kidney injury
ARDS
acute respiratory distress syndrome
BP
blood pressure
BNP
brain natriuretic peptide
CNI
calcineurin inhibitor
COVID-19
Coronavirus Disease 2019
CT
computed tomography
CRP
C-reactive protein
Cr
creatine
CRRT
continuous renal replacement therapy
CMV
cytomegalovirus
eGFR
estimated glomerular filtration rate
DCD
donation after cardiac death
ESRD
end-stage renal disease
FiO2
fraction of inspiration O2
HR
heart rate
IVIG
intravenous immunoglobulin
ICU
intensive care unit
MP
methylprednisolone
MMF
mycophenolate mofetil
NAT
nucleic acid testing
PCT
procalcitonin
PaO2
partial pressure of oxygen
PJP
Pneumocystis jiroveci pneumonia
RTRs
renal transplant recipients
SPO2
pulse oxygen saturation
SARS-CoV2
severe acute respiratory syndrome-Coronavirus 2
WHO
world health organization
WBC
white blood cell

Cited by (0)

1

These authors contributed equally as co-first authors.

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