SARS-COV-2 infection in the early post-transplant period after a living donor kidney transplant

Abstract
Introduction: Coronavirus disease 2019 (COVID-19) pandemic presented multiple challenges for living and deceased donor kidney transplant programs with the likelihood of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) We report the course of COVID-19 and immunosuppression within 3 months of living donor kidney transplant (LDKT) which has not been described previously Case Description: Three LDKT recipients developed COVID-19 in the early posttransplant period and were detected positive for SARS-CoV-2 at day 7, day 19 and 2 months post-transplant Patients 1 and 2 had received 1 mg/kg of anti-thymocyte globulin (ATG) as induction and patient 3 had received no induction at the time of transplant Patients 1 and 2 had minimal symptoms at diagnosis, whereas patient 3 had high grade fever, cough and shortness of breath All 3 patients had lymphopenia at diagnosis and none required supplemental oxygen or intensive care unit monitoring All 3 patients received azithromycin and hydroxychloroquine Mycophenolate mofetil dose was reduced in patient 1 and was stopped in patients 2 and 3 Patient 3 developed acute kidney injury with a peak serum creatinine of 2 4 mg/dL, whereas other 2 patients did not develop kidney allograft dysfunction All 3 patients recovered from SARS-CoV-2 infection with normal renal function at discharge Discussion: Limited experience of SARS-CoV-2 infection in early post-transplant period is available in deceased donor kidney transplant (DDKT) with serious morbidity and mortality implications Lymphopenia described in patients with severe illness due to SARS-CoV-2 can be aggravated by recently used higher dose of lymphocyte depleting agent, especially to cover for delayed graft function in DDKT As compared to previously reported cases of DDKT, our relatively young recipients of LDKT had a milder course, minimal complications and recovered from SARS-CoV-2 infection We suggest consideration of recipient age, pretransplant isolation and using induction agent basiliximab or lower dose of ATG for a LDKT program during COVID-19 pandemic
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