Successful Treatment of Transplanted Kidney Patient with 100% Lung Damage Caused by COVID-19 Bilateral Pneumonia: a Clinical Case

Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.

Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.

Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.

Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.

Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment. 

1. Gautier S.V., Shevchenko A.O., Tsirulnikova O.M., Khomyakov S.M., Kotenko O.N., Vinogradov V.E., et al. COVID-19 in solid organ transplant recipients: initial report from national multicenter observational study “ROKKOR-recipieni”. Russian Journal of Transplantology and Artificial Organs. 2020;22(3):8–17 (In Russ.). DOI: 10.15825/1995-1191-2020-3-8-17

2. Shebaev G.A., Nartailakov M.A., Nagaev R.Ya., Nikolaeva I.E., Kurbangulov I.R., Nuriakhmetov R.R. Development of organ donationin the Republic of Bashkortostan. Bashkortostan Medical Journal. 2013;8(6):8–11 (In Russ.).

3. Prevention, diagnosis and management of a novel coronavirus infection (COVID-19): temporary methodological recommendation. Revision 9 (26/10/2020). Available from: https://minzdrav.gov.ru/system/attachments/attaches/000/052/548/original/%D0%9C%D0%A0_COVID-19_%28v.9%29.pdf (In Russ.).

4. Alberici F., Delbarba E., Manenti C., Econimo L., Valerio F., Pola A., et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int. 2020;97(6):1083–8. DOI: 10.1016/j.kint.2020.04.002

5. Gagliardi I., Patella G., Michael A., Serra R., Provenzano M., Andreucci M. COVID-19 and the kidney: from epidemiology to clinical practice. J Clin Med. 2020;9(8):2506. DOI: 10.3390/jcm9082506

6. Cheng Y., Luo R., Wang K., Zhang M., Wang Z., Dong L., et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829–38. DOI: 10.1016/j.kint.2020.03.005

7. Frolova N.F., Usatyuk S.S., Artyukhina L.YU., Kotenko O.N., MAyorov V.V., Lysenko M.A. New coronavirus infection COVID-19 in a patient after kidney allotransplantation. Clinical nephrology. 2020;2:16–20 (In Russ.). DOI: 10.18565/nephrology.2020.2.16-20

8. Henry B.M., Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020:52(6):1193–4. DOI: 10.1007/s11255-020-02451-9

9. Glybochko P., Fomin V., Avdeev S., Moiseev S., Yavorovskiy A., Brovko M., et al. Clinical characteristics of 1007 intensive care unit patients with SARS-CoV-2 pneumonia. Clinical pharmacology and therapy. 2020;29(2):21–9 (In Russ.).

10. WHO Coronavirus Disease (COVID-19) pandemic statistics [updated 2021 August 31]. Available from: https://covid19.who.int/region/euro/country/ru

11. Siddiqi H.K., Mehra M.R. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405–7. DOI: 10.1016/j.healun.2020.03.012

12. Brienza N., Puntillo F., Romagnoli S., Tritapepe L. Acute kidney injury in coronavirus disease 2019 infected patients: a meta-analytic study. Blood Purif. 2021;50(1):35–41. DOI: 10.1159/000509274

13. Gori A., Dondossola D., Antonelli B., Mangioni D., Alagna L., Reggiani P., et al. Coronavirus disease 2019 and transplantation: A view from the inside. Am J Transplant. 2020;20(7):1939–40. DOI: 10.1111/ajt.15853

14. Wang J., Li X., Cao G., Wu X., Wang Z., Yan T. COVID-19 in a kidney transplant patient. Eur Urol. 2020;77(6):769–70. DOI: 10.1016/j.eururo.2020.03.036

15. Temporary methodological recommendations. Prevention, diagnosis and management of a novel coronavirus infection (COVID-19): temporary methodological recommendation. Revision 11 (07.05.2021). Ministry of Health of the Russian Federation; 2021. Available from: https://minzdrav.gov.ru/system/attachments/attaches/000/055/735/original/BМР_COVID-19.pdf (In Russ.).