ABSTRACT
Introduction: With regard to immunosuppression and the high level of cardiovascular comorbidity renal transplant recipients are supposed to be at substantially increased risk for an adverse course of COVID-19. To date, there are no data on the psychological effects of this knowledge on renal transplant recipients during the pandemic. Methods: Cross sectional study on 62 renal transplant recipients and 30 nephrological outpatients without immunosuppression, who served as control. The study aimed at an assessment of anxiety, mood, and quality of life during the pandemic (April 2020) and six months before. The analysis was performed by means of a questionnaire derived from KPD-38. The KPD-38 encompasses 38 questions on 6 parameters. We extracted 6 questions focussing on two parameters: life satisfaction and competence to act. The corresponding scales ranged from 1 to 4. Statistical analysis was performed using the Wilcoxon Test for the intragroup comparison of the two timepoints and the Mann-Whitney U test for intergroup comparisons. Results: The renal transplant recipients had a mean level of satisfaction of 5.4±1.9 in April 2020 during the pandemic compared to 6.4±1.6 six months ago (p=0.0001). In the control group the life satisfaction was lower during the pandemic than six months ago as well (5.6±1.6 vs. 6.7±2.6, p=0.0073). The level of satisfaction during the pandemic did not significantly differ between transplant recipients and controls (p=0.69). In analogy to the parameter 'life satisfaction', the parameter 'competence to act' was higher before than during the pandemic in both renal transplant recipients(12.7±3.0 vs. 14.7±2.7, p<0.0001) and control subjects (13.3±3.1 vs. 14.7±2.7, p=0.016) and showed no significant difference between the two groups during the pandemic (12.7±3.0 vs. 13.3±3.1, p=0.361). Conclusion: Life satisfaction and the feeling of 'competence to act' were significantly reduced during the COVID-19 pandemic in renal transplant recipients. This phenomenon, however, occurred in the same way in nonimmunocompromised subjects with CKD.
ABSTRACT
Introduction: COVID-19 primarily affects epithelia of the upper and lower respiratory tract. Thus, impairment of kidney function has been primarily attributed to secondary effects like cytokine release or fluid balance disturbances so far. Methods: We provide evidence that SARS-CoV-2 can directly infiltrate a kidney allograft. Results: A 69-year old male pancreas-kidney transplant recipient presented to our hospital with COVID-19 pneumonia and impaired pancreas and kidney allograft function. Kidney biopsy was performed showing tubular damage and an interstitial mononuclear cell infiltrate. RT-PCR from the biopsy specimen was positive for SARS-CoV-2, while being negative in a peripheral blood sample. Subsequently, he suffered from two convulsive seizures. Magnetic resonance tomography suggested meningoencephalitis, which was confirmed by SARS-CoV-2 RNA transcripts in the cerebrospinal fluid. Conclusion: The present case demonstrates that SARS-CoV-2 can infiltrate diverse organs. The patient suffered from COVID-19 pneumonia, meningoencephalitis and nephritis. SARS-CoV-2 binds to its target cells through angiotensin-converting enzyme 2, which is expressed in a broad variety of tissues including the lung, brain and kidney. SARS-CoV-2 thereby shares features with other human coronaviruses including SARS-CoV that were identified as pathogens beyond the respiratory tract as well. The present case should provide awareness that extrapulmonary symptoms in COVID-19 may be attributable to viral infiltration of diverse organs.