key: cord-1004250-hipfp2c4
authors: Bhandari, Tika Ram; Shrestha, Kalpana Kumari; Shrestha, Pukar Chandra
title: COVID‐19 infection in renal transplant recipients in early post‐renal transplantation period: Report of three cases
date: 2022-04-19
journal: Transpl Infect Dis
DOI: 10.1111/tid.13837
sha: b15291530b552671c1b7f14edf060d6d5fd9d088
doc_id: 1004250
cord_uid: hipfp2c4

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All received valganciclovir for cytomegalovirus prophylaxis and trimethoprim-sulfamethoxazole was given for Pneumocystis carinii pneumonia prophylaxis. All three patients were stable in terms of respiratory symptoms throughout the initial transplant hospital stay.

All patients developed symptoms during the hospital stay, triggering COVID test. We did not identify definitive sick contacts of these cases.

After the patient tested positive, they were kept in hospital isolation with close monitoring of symptoms and conservative management.

The early urine output was outstanding in all three patients. On POD 3, C-reactive protein levels and oxygen levels remained normal in patients 2 and 3 and they were discharged from the hospital on 5th and 7th days with improved symptoms. They remained well without complications.

Patient 1 remained hospitalized for 15 days due to delayed graft function (DGF) but was discharged with a serum creatinine (SCr) of 3.9 mg/dl. Oxygen saturation remained normal throughout the initial hospital stay and his symptoms improved prior to discharge. On 24th POD, he was readmitted with severe pneumonia ( Figure 1A ,B). He was intubated and had a mechanical ventilator initiated on 28th POD for respiratory failure. MMF was held and the dosage of prednisolone was increased. He also received a single dose of 400 mg of tocilizumab.

Unfortunately, despite all efforts, he passed away due to COVID pneumonia.

These three cases contribute to our understanding of COVID-19

in newly transplanted patients. Kolonko According to some literature, it is essential to adjust the posttransplant immunosuppression regimens, depending upon the clinical scenario of the virus-infected patients. 6 In all three patients, the level of TAC was different and tried to maintain around 6-8 ng/ml. Initially, the doses of prednisone had been decreased in all three patients to prevent further escalation of symptoms, however, the doses of prednisone increased to 40 mg/day in patient 1 when he developed severe pneumonia. Despite holding MMF and giving tocilizumab the patient progressed and died. 6, 7 

COVID-19 infection in solid organ transplant recipients: a single-center experience with patients immediately after transplantation

Coronavirus disease 2019 in renal transplant recipients: report of two cases

Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19)

Kidney transplant programmes during the COVID-19 pandemic

Kidney transplantation with presymptomatic COVID-19-positive surgeon

Managing COVID-19 in renal transplant recipients: a review of recent literature and case supporting corticosteroid-sparing immunosuppression

Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review

COVID-19 infection in renal transplant recipients in early post-renal transplantation period: report of three cases

The authors have no conflict of interest to disclose.

Tika Ram Bhandari participated in the study concept, data collection, and writing of the original manuscript. Kalpana Kumari Shrestha and Pukar Chandra Shrestha participated in the study concept and critically revised the manuscript. BHANDARI ET AL.

No sponsor was involved in the study.