Subject(s)
COVID-19/virology , Descemet Stripping Endothelial Keratoplasty , Endothelium, Corneal/virology , Eye Infections, Viral/virology , Graft Rejection/virology , SARS-CoV-2/isolation & purification , Aged , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Endothelium, Corneal/pathology , Eye Infections, Viral/diagnosis , Female , Graft Rejection/diagnosis , Humans , Retrospective Studies , Visual Acuity/physiologyABSTRACT
There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.
Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Graft Rejection/virology , Lung Transplantation , Respiratory Distress Syndrome , COVID-19/complications , Fatal Outcome , Humans , Lung Transplantation/adverse effects , Male , Middle Aged , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virologyABSTRACT
We describe the unique disease course and cure of SARS-CoV-2 infection in a patient with SCID and graft failure. In absence of a humoral immune response, viral clearance was only achieved after transfusion of convalescent plasma. This observation underscores the necessity of the humoral immune response for SARS-CoV-2 clearance.
Subject(s)
COVID-19/therapy , SARS-CoV-2/physiology , Severe Combined Immunodeficiency/complications , Adult , Antibodies, Viral/blood , COVID-19/complications , COVID-19/immunology , COVID-19/virology , Female , Graft Rejection/complications , Graft Rejection/immunology , Graft Rejection/virology , Humans , Immunization, Passive , Severe Combined Immunodeficiency/immunology , Severe Combined Immunodeficiency/virology , Sustained Virologic Response , Viral Load , Virus Replication , COVID-19 SerotherapyABSTRACT
A 32-year-old man with a clear and compact graft following a penetrating keratoplasty 6 years back, developed an episode of acute graft rejection, coinciding with the COVID-19 disease. Subsequent to the infection with the novel coronavirus, he developed symptoms of acute graft rejection concurrent with the development of respiratory distress and peak systemic symptoms. This was the phase of cytokine storm as evidenced by the raised inflammatory markers in his blood tests. Such a case of acute corneal graft rejection coinciding with SARS-CoV-2 infection has been reported only once in the literature and this unique association needs to be researched further.
Subject(s)
COVID-19/diagnosis , Corneal Diseases/diagnosis , Eye Infections, Viral/diagnosis , Graft Rejection/diagnosis , Keratoplasty, Penetrating , SARS-CoV-2 , Acute Disease , Adult , COVID-19/virology , COVID-19 Nucleic Acid Testing , Cataract Extraction , Corneal Diseases/drug therapy , Corneal Diseases/virology , Cytokines/blood , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Glucocorticoids/therapeutic use , Graft Rejection/drug therapy , Graft Rejection/virology , Humans , Incidence , Inflammation Mediators/blood , Lens Implantation, Intraocular , Male , Pneumonia, Viral/blood , Prednisolone/therapeutic use , Visual Acuity , COVID-19 Drug TreatmentABSTRACT
There is uncertainty about the safety of kidney transplantation during the SARS-CoV-2 pandemic due to the risk of donor transmission, nosocomial infection and immunosuppression use. We describe organ donation and transplant practice in the UK and assess whether kidney transplantation conferred a substantial risk of harm. Data from the UK transplant registry were used to describe kidney donation and transplant activity in the UK, and a detailed analysis of short-term, single-center, patient results in two periods: during the pre-pandemic era from 30th December 2019 to 8th March 2020 ("Pre-COVID era") and the 9th March 2020 to 19th May 2020 ("COVID era"). Donor and recipient numbers fell by more than half in the COVID compared to the pre-COVID era in the UK, but there were more kidney transplants performed in our center (42 vs. 29 COVID vs. pre-COVID respectively). Overall outcomes, including re-operation, delayed graft function, primary non-function, acute rejection, length of stay and graft survival were similar between COVID and pre-COVID era. 6/71 patients became infected with SARS-CoV-2 but all were discharged without critical care requirement. Transplant outcomes have remained similar within the COVID period and no serious sequelae of SARS-CoV-2 infection were observed in the peri-transplant period.