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Kidney Week

Abstract: PO0798

Successful Recovery of COVID-19 Pneumonia in a Kidney Transplant Recipient with a Regimen Consisting of Favipiravir, Azithromycin, Nafamostat Mesylate (NM), and Intravenous Immunoglobulin (IVIg)

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Hidaka, Sumi, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Ishioka, Kunihiro, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Moriya, Hidekazu, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Mochida, Yasuhiro, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Suzuki, Hiroyuki, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Ohtake, Takayasu, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
  • Kobayashi, Shuzo, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
Introduction

The SARS-CoV-2 virus has caused a worldwide pandemic of coronavirus disease 2019 (COVID-19) since end of 2019. Although COVID-19 has been widely reported, little is known about its impact on transplant recipients. We report a case of an interstitial pneumonia due to SARS-CoV-2 viral infection in a kidney transplant recipient. We also investigated how treatment of COVID-19 influenced the changes of lymphocyte subset and the number and activity of NK cells.

Case Description

This is a 49-year-old man who received kidney transplantation 13 months ago. His first clinical symptoms were of high fever, general fatigue, and myalgia. He had no complaints of cough nor shortness of breath, but his chest CT revealed interstitial pneumonia with SpO2 90 - 92 mmHg. Nasopharyngeal swab for SARS-CoV-2 RT-PCR assay was reported positive. He also showed acute kidney injury (AKI), whose serum creatinine level got elevated from 1.33 mg/dL to 1.67 mg/dL. We stopped tacrolimus and mycophenolate mofetil and continued low dose of methylprednisolone. The COVID-19 pneumonia and AKI were successfully treated with the regimen consisting of favipiravil, azithromycin, NM, and IVIg. On the 14th hospital day, the SARS-CoV-2 RT-PCR had become negative and simultaneously had acquired IgG antibody against SARS-CoV-2 virus. Regarding lymphocyte subset, the percentage of CD19+ B lymphocytes has been extremely low level because of administration of rituximab 13 months ago due to ABO-incompatible living related-donor kidney transplantation. On the day of admission, the total number of lymphocytes was only 482/μL and most of them were CD4+ lymphocytes and the number of NK cells were very few (6.8%). As the symptoms improved, the number and activity of NK cells increased and the proportion of CD4+ lymphocytes decreased.

Discussion

We successfully treated the patients with 4 off-label drugs against COVID-19, consisting of favipiravil, azithromycin, NM, and IVIg. Our current regimen seems to be successful, in particular, NM seems to block cytokine storm, thus preventing from serious illness, but a larger cohort of patients is required. Activation and expansion of NK cells are important in the treatment of COVID-19.