Severe acute respiratory syndrome coronavirus 2 infection in renal transplant recipients: A case report

  • Qiu-yu LI ,
  • Qin CHENG ,
  • Zhi-ling ZHAO ,
  • Ni-ni DAI ,
  • Lin ZENG ,
  • Lan ZHU ,
  • Wei GUO ,
  • Chao LI ,
  • Jun-hong WANG ,
  • Shu LI ,
  • Qing-gang GE ,
  • Ning SHEN
Expand
  • 1. Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
    2. Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
    4. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    5. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    6. Department of Emergency, Peking University Third Hospital, Beijing 100191, China

Received date: 2020-04-12

  Online published: 2020-08-06

Supported by

National Natural Science Foundation of China(81900641);Fundamental Research Funds for the Central Universities: the Special Research Fund of PKU for Prevention and Control of COVID-19(BMU2020HKYZX011);National R&D Program of China(2020YFC0844500);National R&D Program of China(2020YFC0844900)

Abstract

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.

Cite this article

Qiu-yu LI , Qin CHENG , Zhi-ling ZHAO , Ni-ni DAI , Lin ZENG , Lan ZHU , Wei GUO , Chao LI , Jun-hong WANG , Shu LI , Qing-gang GE , Ning SHEN . Severe acute respiratory syndrome coronavirus 2 infection in renal transplant recipients: A case report[J]. Journal of Peking University(Health Sciences), 2020 , 52(4) : 780 -784 . DOI: 10.19723/j.issn.1671-167X.2020.04.033

References

[1] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020,395(10223):507-513.
[2] Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients[J]. Am J Transplant, 2009,9(Suppl 3):S1-155.
[3] Kumar D, Michaels MG, Morris MI, et al. Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study[J]. Lancet Infect Dis, 2010,10(8):521-526.
[4] Zhang H, Chen Y, Yuan Q, et al. Identification of kidney transplant recipients with coronavirus disease 2019[J]. Eur Urol, 2020,77(6):742-747.
[5] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China[J]. JAMA, 2020,323(11):1061-1069.
[6] Lansbury L, Rodrigo C, Leonardi-Bee J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza [J]. Cochrane Database Syst Rev, 2019, 2(2): CD010406.
[7] Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury[J]. Lancet, 2020,395(10223):473-475.
Outlines

/