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Kidney Week

Abstract: PO0761

COVID-19 Infection in Kidney Transplant Recipients: A Single-Center Experience

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Andrea, Tyler, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Hussain, Sabiha Malik, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Introduction

The SARS-CoV-2 (COVID-19) pandemic presents significant challenges to kidney transplant recipients (KTRs) with risk for higher mortality yet sparse available data. We present our single center experience of COVID-19 infection in KTRs.

Case Description

Methods
We reviewed the electronic health records of KTRs with confirmed COVID-19 infection using rt-PCR testing via nasopharyngeal swabs, at our transplant center.
Results
We identified four KTRs with diagnosed COVID-19 infection in our institution. Details of individual cases are summarized in table 1. Patient A died of complications while patients B, C and D fully recovered. Patient A initially recovered from COVID-19 pneumonia but then was readmitted three weeks later and developed features closely resembling macrophage activation syndrome (MAS) and hemophagocytic lymphohistiocytosis (HLH) leading to death despite treatment with dexamethasone, IV immunoglobulin and anakinra. Patient C had minimal symptoms without cytokine storm possibly related to complement blockade from revulizumab, a C5 inhibitor, which was being used for treatment of aHUS.

Discussion

Our single center case series of COVID-19 infections in KTRs is small but highlights two important aspects: 1) development of MAS/HLH like features in patient A which to our knowledge has not been described in the setting of COVID-19 infection in KTRs; 2) development of minimal symptoms without cytokine storm in patient C likely related to use of C5 blocking agent revulizumab. Further studies are needed to shed light on these phenomenon.

Case series of varied clinical manifestation of COVID 19 infection at our center
CaseAge/SexEthnicityTypeESKD CauseInductionTime from Transplant (Months)ComorbiditiesBaseline ImmunosuppressionSymptomsImmunosuppression Changes During InfectionCr Baseline (mg/dL)Acute Kidney InjuryCr at last follow-up (mg/dL)Clinical CourseVentilator SupportTreatmentComplicationsFollow-Up
A70MCaucasianLURDDM2Thymo59HTN, CAD, CHF, Pulmonary Hypertension, COPD, DM2, ObesityTacrolimus + MMFDyspnea, Fever, coughTacrolimus switched to Cyclosporine, MMF held; started Dexamethasone1.8Yes requiring Dialysis4.2ICUYesHydroxychloroquine; Steroids, IVIG, AnakinraAKI, dialysis; eosinophilia, elevated inflammatory markers, thrombocytopeniaAllograft biopsy - ATN; Bone Marrow biopsy - Likely MAS/HLH; cardiopulmonary arrest leading to Death
B55MCaucasianLURDPCKDThymo5HTNTacrolimus + MMFDyspnea, cough; diarrheaTacrolimus (lowered goal to 4-6 ng/mL); MMF held; started Prednisone.1.5Yes peak Cr 2.6 mg/dL1.4AdmitNoHydroxychloroquine, AzithromycinAKI which recoveredContinued Prednisone 5 mg daily 21 days then resumed MMF
C62MCaucasianDCDDM2, aHUSThymo2HTN, CAD, CHF, DM2, ObesityBelatacept + MMF + Prednisone + RevulizumabSore Throat, Cough, FeverMMF held1.4No1.4HomeNoSupportive careNoneResumed MMF after 21 days, no missed infusions of Belatacept or Revulizumab
D43FAfrican AmericanDCDFSGSThymo20HTN, ObesityTacrolimus + MMF + PrednisoneAnosmia, Sore Throat, Myalgias, Diarrhea, Fever, CoughTacrolimus (lowered goal to 4-6 ng/ml); MMF held1.3No1.3HomeNoHydroxychloroquine, ACE-I heldNoneResumed MMF and ACEi

aHUS – atypical hemolytic uremic syndrome; DCD – donation after cardiac death; LURD – living unrelated donor; MMF – Mycofenolate Mofetil; THYMO – rabbit antithymocyte globulin, Cr- Creatinine,