key: cord-0860238-erfee4h6
authors: Abrishami, Alireza; Samavat, Shiva; Behnam, Behdad; Arab-Ahmadi, Mehran; Nafar, Mohsen; Sanei Taheri, Morteza
title: Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients
date: 2020-05-06
journal: Eur Urol
DOI: 10.1016/j.eururo.2020.04.064
sha: 138a25c18c822aa7d8b9bf456744e04c12f0d46d
doc_id: 860238
cord_uid: erfee4h6

Abstract Coronavirus disease 2019 (COVID-19) is a novel and highly contagious disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and patients with comorbidities and immunosuppressive conditions may experience severe signs and symptoms that can lead to death. This case series assesses the clinical course, imaging features, and outcomes for 12 patients with COVID-19 and a history of kidney transplantation. Patients were evaluated for symptoms, laboratory data, imaging findings, and outcomes from February 2020 to April 2020. Fever, cough, and dyspnea were the most common clinical symptoms, noted in 75% (nine/12), 75% (nine/12), and 41.7% (five/12) of the patients, respectively. Most of the patients had a normal white blood cell count, while 33.3% (four/12) had leukopenia and 8.3% (one/12) had leukocytosis. A combination of consolidation and ground glass opacity was the most predominant (75%) pattern of lung involvement on computed tomography (CT). Eight patients died of severe COVID-19 pneumonia and acute respiratory distress syndrome and four were discharged. All recovered cases had a unilateral peripheral pattern of involvement limited to only one zone on initial chest CT. It seems that CT imaging has an important role in predicting COVID-19 outcomes for solid organ transplant recipients. Future studies with long-term follow up and more cases are needed to elucidate COVID-19 diagnosis, outcome, and management strategies for these patients.

Case series 13 1.1. Background 14 On December 31, 2019, a nov Q7 el corona virus was extracted 15 from the respiratory secretions of several patients present- 16 ing with lower respiratory tract infection of unknown origin 17 in Wuhan, China [1] . While the mortality rate of coronavirus 18 disease 2019 (COVID-19) is believed to be approximately 5% 19 [2] , older adults and those with an underlying chronic 20 disease are specifically at high risk of presenting with severe 21 symptoms, having poorer prognosis, and even developing 22 fatal conditions [3] . Use of immunosuppressive medications 23 such as steroids may also be linked to severe manifestation E U R O P E A N U R O L O G Y X X X ( 2 0 1 9 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m of the disease, as in patients with previous respiratory viral 25 infections such as H1N1 [4] . 26 Solid organ transplant recipients are on long-term 27 immunosuppressive regimens and are at particular risk of 28 contracting severe respiratory tract infection and possibly 29 with atypical presentation [5] . (Table 4) . 122 We did not observe cavitation, cystic changes, or progressive radiologic changes such as bilateral areas of air 136 space opacity (Fig. 2) .

Of the 12 patients, ten were admitted to an intensive care another study [13] . In contrast to our results, Fishman and

Grossi [14] reported that leukopenia and lymphopenia were E U R O P E A N U R O L O G Y X X X ( 2 0 1 9 ) X X X -X X X involvement and subsegmental consolidation [17] .

Our study revealed that interlobular septal thickening, 

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