Discussion:
Kidney transplant recipients have a high susceptibility to viral
pneumonia due to receiving high-dose immunosuppressive drugs (4). Here,
we report a case of COVID-19 in a renal transplant patient. The
diagnosis was based on clinical symptoms and findings on a chest CT
scan, confirmed by real-time PCR assays.
Kidney transplant recipients infected with Coronavirus have a
significant risk of graft loss and death. However, the psychosocial
impact of the COVID-19 pandemic on graft and patient outcomes in
non-COVID kidney transplant recipients is unclear (5).
Immunosuppressant drugs ordered by nephrologists may increase
susceptibility to many viral infections with differences in clinical
presentation and therapeutic responses compared with the general
population (6).
Acute kidney injury is not uncommon in COVID-19 and was seen in some
studies reported in the literature, but Its pathophysiology remains
uncertain. The direct parenchymal infection by the virus and
microangiopathy mediated by inflammatory responses have been suggested
(7).
There were only a few acute rejection reports in the covid patient in
the literature(8). There may be additional mechanisms for rejection in
this setting in transplanted kidney patients with Coronavirus. Low dose
immunosuppression or calcineurin inhibitor toxicity through drug-drug
interactions (e.g., lopinavir/ritonavir) are suggested mechanisms (9).
However, due to the small number of studies, it remains unclear whether
the natural course of COVID-19 is responsible for rejection in
transplant recipients or reducing the immunosuppressive regimen led to
playing a part during the disease (5).
To the best of our knowledge, the
reported case of transplant recipient with COVID-19 is rare. Clinical
data of transplant recipients and management of the anti-rejection
immunosuppressive therapy on COVID-19 infection are lacking (9).
Until
now, there is no specific recommendation for therapeutic agents in
COVID-19, and supportive care is the best management strategy (10).
We report COVID-19 infection in a
renal transplant recipient with a favorable outcome but different
clinical courses, which may provide a reference value for treating such
patients.