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.