Severe Covid-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone


Abstract

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 - whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient's condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection. © 2021 Suryantoro et al.

Keywords: COVID-19; Hydroxycholorquin; Immunosupressive drugs; Kidney transplant; Lopinavir/ritonavir

 

Introduction

At the end of 2019, a number of cases of pneumonia with unknown etiology emerged in Wuhan, Hubei Province, China. This novel type of pneumonia spread rapidly to the other Chinese districts and provinces and eventually to almost every part of the world. On January 7, 2020, a new type of coronavirus was identified in an oropharyngeal swab sample from one patient by the Chinese Center for Disease Control and Prevention (CDC) and was later named Novel Coronavirus 2019 (2019 n-CoV) by the World Health Organization (WHO) [1,2].COVID-19 infection majorly presents as an acute respiratory illness with signs of pneumonia yet it can also affect many extrapulmonary organ include heart, kidneys, digestive tract, haematological and central nervous system [3]. Approximately 20% of COVID-19 patients manifest moderate to severe symptoms and 5% fall to critically ill [4]. Risk factor identified for severe disease include age, underlying diseases such as diabetes, hypertension, chronic kidney disease, morbid obesity, coronary heart disease, and chronic lung disease [5]. Solid organ transplant recipients are susceptible of SARS CoV-2 infection because of their chronic immunosuppression to prevent rejection especially diabetes and hypertension [5]. Although renal transplant recipients are susceptible of the virus, only few reports of COVID-19 infection in kidney transplant patient have been published [6]. Specific question arises for renal transplant recipients infected COVID-19, whether the infection will get worse in patients receive immunosuppresive agent and it should be stopped or not [3



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