ABSTRACT
Over 1 000 000 cases of coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide outbreak began. Not enough data on infected solid organ transplant (SOT) recipients are available, especially data about the management of immunosuppressants. We report two cases of COVID-19 in two transplant recipients, with different treatments and prognoses. The first patient received liver transplantation due to hepatitis B virus-related hepatocellular carcinoma and was confirmed to have COVID-19 9 days later. Following a treatment regimen consisting of discontinued immunosuppressant use and low-dose methylprednisolone-based therapy, the patient developed acute rejection but eventually recovered. The other patient had undergone a renal transplant from a living-related donor 17 years ago, and was admitted to the hospital because of persistent fever. This patient was also diagnosed with COVID-19. His treatment regimen consisted of reduced immunosuppressant use. No signs of rejection were observed during the regimen. In the end, the patient successfully recovered from COVID-19. These effectively treated cases can provide a basis for immunosuppressant management of COVID-19-positive SOT recipients.
Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Immunosuppressive Agents/therapeutic use , Organ Transplantation , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Transplant Recipients , Adult , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Hepatitis B/complications , Hepatitis B/surgery , Hepatitis B virus , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation , Male , Methylprednisolone/administration & dosage , Middle Aged , Pandemics , Prognosis , SARS-CoV-2 , Treatment OutcomeABSTRACT
Liver injury is common in patients with COVID-19, but little is known about its clinical presentation and severity in the context of liver transplant. We describe a case of COVID-19 in a patient who underwent transplant 3 years ago for hepatocellular carcinoma. The patient came to clinic with symptoms of respiratory disease; pharyngeal swabs for severe acute respiratory syndrome coronavirus 2 were positive. His disease progressed rapidly from mild to critical illness and was complicated by several nosocomial infections and multiorgan failure. Despite multiple invasive procedures and rescue therapies, he died from the disease. The management of COVID-19 in the posttransplant setting presents complex challenges, emphasizing the importance of strict prevention strategies.
Subject(s)
Carcinoma, Hepatocellular/complications , Coronavirus Infections/complications , End Stage Liver Disease/complications , Hepatitis B/complications , Liver Neoplasms/complications , Liver Transplantation , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/surgery , Coronavirus Infections/therapy , Cross Infection/complications , End Stage Liver Disease/surgery , Fatal Outcome , Hepatitis B/surgery , Humans , Immunocompromised Host , Immunosuppression Therapy , Immunosuppressive Agents/therapeutic use , Liver Neoplasms/surgery , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Postoperative Complications , Radiography, Thoracic , SARS-CoV-2 , Tomography, X-Ray Computed , Transplant Recipients , Treatment OutcomeABSTRACT
Coronavirus disease 2019 (COVID-19) pandemic spreads rapidly and may be an increasing challenge for transplant community. Clinical data on COVID-19 infection in transplant population is very limited. Herein we presented the clinical course and outcome of a 50-year-old male post liver transplantation who contracted COVID-19, with subsequent infection of his wife. The process of illness was representative. A therapeutic regime with temporary immunosuppression withdrawal and systemic low-dose corticosteroid as principle was involved in the management of the patient which made him recover from severe COVID-19 pneumonia.