SARS Cov-2 infection in a renal-transplanted patient: A case report

COVID-19 pneumonia in a kidney transplant recipient successfully treated with tocilizumab and hydroxychloroquine

“…2 COVID-19 is considered as potentially having a more severe course in solid organ transplant recipients, due to the chronic immunosuppression these patients are exposed to for preventing rejection. Only a few reports of COVID-19 in kidney transplanted patients are currently available in the literature, [3][4][5][6][7] and prognosis and recommended management for these patients are unclear. Moreover, the impact of treatments other than best supportive care is unknown.…”

Managing COVID‐19 in Renal Transplant Recipients: A Review of Recent Literature and Case Supporting Corticosteroid‐sparing Immunosuppression

“…Recipients described were between 1 month and 22 years post‐transplant with most patients presenting with severe respiratory symptoms requiring oxygen. Immunosuppressant management in 30 patients consisted of complete cessation of calcineurin inhibitor and antiproliferative therapy with reliance on corticosteroid monotherapy, typically with intravenous methylprednisolone 4,7‐17 . Only three patients were managed without making any change in their baseline immunosuppressive regimen, and one of these patients was receiving a steroid‐sparing regimen at baseline.…”

“…Only three patients were managed without making any change in their baseline immunosuppressive regimen, and one of these patients was receiving a steroid‐sparing regimen at baseline. Of these three patients, none progressed to mechanical ventilation, and all had a shorter duration of symptoms than average, lasting ~2 weeks or less 7,10 . Only one other case reported a steroid‐sparing regimen at baseline; this patient’s immunosuppression was managed with cessation of antiproliferative therapy and dose reduction in tacrolimus; however, methylprednisolone 40 mg/day was also added for the duration of hospitalization.…”

“…Additionally, broad‐spectrum antibiotic therapy was administered to 34 patients. The average duration of symptoms from those who reported was 21 days, with 18% of patients progressing to respiratory failure requiring mechanical ventilation 4,7‐17 . Eight patients who had presented with severe or critical oxygen needs had died by the time of case publication; all eight patients had immunosuppressant therapy converted to corticosteroid monotherapy while hospitalized 8,11,15,16 …”

“…At this time, supportive care is paramount to combating this virus in solid organ transplant recipients. Very little data are currently available regarding the optimal medical management of renal transplant patients testing positive for SARS‐CoV‐2 including strategies for reducing or modifying immunosuppression 4,7‐17 . Corticosteroids are a cornerstone of many immunosuppressive regimens; however, their use in SARS‐CoV‐2 is controversial 18‐22 .…”