ABSTRACT
INTRODUCTION: An outbreak of coronavirus disease-19 (COVID-19) has occurred in different parts of the world. Although a large piece of information regarding the epidemiology, clinical features, and management of COVID-19 has been reported in the general population, there is very limited data regarding organ transplant recipients, particularly regarding the management of maintenance immunosuppressive agents during infection. METHODOLOGY: We described a case of kidney transplant recipient from Thailand who had COVID-19 pneumonia and severe acute kidney injury. RESULTS: The patient's serum creatinine peaked at 7.0 mg/dL on day 15 of illness and returned to baseline value of 2.0 mg/dL on day 26 of illness. We have shown how we modified tacrolimus, mycophenolate, and steroids in the patient who had received favipiravir and lopinavir/ritonavir for COVID-19 pneumonia. CONCLUSIONS: In this case, successful modification of this immunosuppressive regimen was accomplished to reduce drug interaction complications, aiming to avoid calcineurin inhibitor nephrotoxicity while maintaining appropriate levels of immunosuppression to prevent organ rejection and to promote the patient's recovery from infection.
Subject(s)
Acute Kidney Injury/virology , COVID-19 Drug Treatment , Immunosuppressive Agents/administration & dosage , Acute Kidney Injury/drug therapy , Adult , Amides/therapeutic use , Drug Combinations , Drug Interactions , Humans , Kidney Transplantation , Lopinavir/therapeutic use , Male , Mycophenolic Acid/administration & dosage , Pyrazines/therapeutic use , Ritonavir/therapeutic use , Steroids/administration & dosage , Tacrolimus/administration & dosage , Thailand , Transplant RecipientsSubject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Kidney Failure, Chronic/complications , Kidney Transplantation , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Aged , Betacoronavirus , COVID-19 , Cobicistat/administration & dosage , Colchicine/administration & dosage , Cytokines/metabolism , Darunavir/administration & dosage , Drug Combinations , Female , Humans , Hydroxychloroquine/administration & dosage , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/surgery , Lopinavir/administration & dosage , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Pandemics , Ritonavir/administration & dosage , SARS-CoV-2 , Tacrolimus/administration & dosage , Tacrolimus/blood , Transplant Recipients , Treatment OutcomeSubject(s)
Azithromycin/administration & dosage , Betacoronavirus/isolation & purification , Coronavirus Infections , Kidney Transplantation/methods , Mycophenolic Acid/administration & dosage , Pandemics , Pneumonia, Viral , Prednisolone/administration & dosage , Tacrolimus/administration & dosage , Anti-Infective Agents/administration & dosage , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Dose-Response Relationship, Drug , Drug Monitoring , Female , Humans , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/surgery , Male , Middle Aged , Monitoring, Immunologic , Oxygen Inhalation Therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Treatment OutcomeABSTRACT
We describe the successful pediatric liver transplant for unresectable hepatoblastoma in a 4-year-old male with COVID-19 prior to transplant. The first negative NP swab was documented 1 month after initial diagnosis, when SARS-CoV-2 antibodies were also detected. The patient was actively listed for liver transplant after completing four blocks of a SIOPEL-4 based regimen due to his PRETEXT IV disease which remained unresectable. Following three additional negative NP swabs and resolution of symptoms for 4 weeks, he underwent a whole-organ pediatric liver transplant. COVID-19 positivity determined via NP swab SARS-CoV-2 real-time RT-PCR (Hologic Aptima SARS-CoV-2 RT-PCR assay). IgG and IgM total SARS- CoV-2 antibodies detected by Ortho Clinical Diagnostics VITROS® Immunodiagnostics Products Anti-SARS-CoV-2 Test. Patient received standard prednisone and tacrolimus-based immunosuppression without induction therapy following transplant. Post-transplant course was remarkable for neutropenia and thrombocytopenia, with discharge home on post-transplant day #11. Surveillance tests have remained negative with persistent SARS-CoV-2 IgG antibodies at 6 weeks after transplant. We describe one of the earliest, if not the first case of liver transplant following recent recovery from COVID-19 in a pediatric patient with a lethal malignant liver tumor. A better understanding of how to balance the risk profile of transplant in the setting of COVID-19 with disease progression if transplant is not performed is needed. We followed existing ASTS guidelines to document clearance of the viral infection and resolution of symptoms before transplant. This case highlights that pediatric liver transplantation can be safely performed upon clearance of COVID-19.
Subject(s)
COVID-19/therapy , Hepatoblastoma/surgery , Liver Neoplasms/surgery , Liver Transplantation/methods , COVID-19/complications , COVID-19 Testing , Child, Preschool , Disease Progression , Hepatoblastoma/complications , Humans , Immunoglobulin G , Immunoglobulin M , Immunosuppression Therapy , Immunosuppressive Agents/administration & dosage , Liver Neoplasms/complications , Male , Neutropenia/complications , Prednisone/administration & dosage , Tacrolimus/administration & dosage , Thrombocytopenia/complications , Treatment OutcomeSubject(s)
Acute Kidney Injury , Coronavirus Infections , Darunavir , Drug Interactions , Hydroxychloroquine , Liver Transplantation/methods , Pandemics , Pneumonia, Viral , Prednisone , Ritonavir , Tacrolimus , Acute Kidney Injury/chemically induced , Acute Kidney Injury/diagnosis , Acute Kidney Injury/prevention & control , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Darunavir/administration & dosage , Darunavir/adverse effects , Drug Monitoring/methods , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/blood , Male , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/physiopathology , Prednisone/administration & dosage , Prednisone/adverse effects , Risk Adjustment/methods , Ritonavir/administration & dosage , Ritonavir/adverse effects , SARS-CoV-2 , Tacrolimus/administration & dosage , Tacrolimus/adverse effects , Tacrolimus/blood , Transplant Recipients , Treatment OutcomeABSTRACT
The clinical manifestation of COVID-19 can vary from an asymptomatic course to ARDS requiring invasive mechanical ventilation and extracorporeal membrane oxygenation. A kidney transplanted patient infected with SARS CoV-2 infection showed a mild disease despite immune suppression. It is possible that Immunosuppression can "be protective" as the cytokine storm is an important factor in the disease story. Despite the good outcome reported in the present case report, is remains of vital importance the solid organ transplant patients use precautions in order to avoid the infection.