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Published on: April 13, 2021
Two distinct cases with COVID-19 in kidney transplant recipients
Yaerim Kim1,2, Ohyun Kwon1, Jin H Paek1,2
1Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Insights
Kidney transplant recipients are vulnerable to COVID-19. This report details two cases, highlighting the need for careful screening, management, and cautious use of antiviral agents, especially concerning drug interactions in transplant patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Kidney transplant (KT) recipients are a vulnerable population susceptible to severe outcomes from COVID-19.
- Limited case reports exist regarding COVID-19 infection in KT recipients, necessitating further clinical insights.
Observation:
- Two distinct cases of COVID-19 in KT recipients are presented: one symptomatic with drug interactions requiring immunosuppressant adjustment, and one asymptomatic.
- Both patients, despite differing clinical presentations and treatments including lopinavir/ritonavir, hydroxychloroquine, and azithromycin, achieved recovery.
Findings:
- Symptomatic COVID-19 in a KT recipient required management of tacrolimus levels due to drug-to-drug interactions with antiviral medications.
- Asymptomatic COVID-19 in another KT recipient showed fluctuating chest lesions but resolved with antiviral therapy.
Implications:
- Assertive screening and tailored management strategies are crucial for improving clinical outcomes in COVID-19 infected KT recipients.
- Antiviral agents must be used with caution in KT recipients, particularly those on calcineurin inhibitors, due to potential drug interactions.
Abstract:
The fatality of novel coronavirus disease 2019 (COVID-19) is precipitously increased in patients with underlying comorbidities or elderly people. Kidney transplant (KT) recipients are one of the vulnerable populations for infection. COVID-19 infection in KT recipients might be a complicated and awkward situation, but there has been a lack of reports concerning this group. Herein, we demonstrated two distinct cases with different clinical progress. The first case was a 36-year-old man who underwent KT 3 years ago. He was diagnosed with COVID-19 expressing relevant symptoms. Following administration of lopinavir/ritonavir and hydroxychloroquine with reduced immunosuppressant, he recovered from COVID-19. However, the unexpected fluctuations in tacrolimus trough levels needed to be managed because of drug-to-drug interaction. The second case was developed in a 56-year-old man without any symptoms. He received a second KT from an ABO-incompatible donor 8 years ago. He was diagnosed with COVID-19 by screening due to exposure history. During the hospitalization period, the chest infiltrative lesion showed a wax and wane, but he successfully recovered by administration of hydroxychloroquine with azithromycin. These apparently different cases suggest that assertive screening and management could improve the clinical course. In addition, antiviral agents should be used cautiously, especially in patients on calcineurin inhibitors.
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