Complete recovery from COVID-19 in kidney-pancreas recipient-potential benefit from everolimus?

ABSTRACT

Background: Novel coronavirus 2019 disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Initially discovered in China in 2019, it has since been declared a worldwide pandemic by the World Health Organisation. There have been limited reports of kidneypancreas recipients with COVID-19, and the overall outcomes in this group of patients is unknown. Case report A 45-year-old man with T3 paraplegia had undergone kidneypancreas transplantation 18 years ago, followed by a subsequent kidneytransplant 9 years ago, and presented with fevers, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma, and an elevated d-dimer were identified as established risk factors for severe COVID-19 disease. The medical history also included previous type 1 diabetes, EBV-associated posttransplant cerebral lymphoma that was treated with rituximab 9 years ago, BK and CMV viraemia. There were no proven COVID-19 specific therapies at the time and supportive management was provided. Oral prednisolone was increased, and baseline immunosuppression with everolimus was continued. A complete recovery was observed. We identify and review the potential mitigating roles of immunosuppression and mTOR-inhibitors in this disease. Conclusions: This is one of few reported cases of COVID-19 in a kidneypancreas transplant recipient. Despite multiple risk factors for severe disease, the outcome was favourable. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.