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. 2020 Jun;77(6):748-754.
doi: 10.1016/j.eururo.2020.03.039. Epub 2020 Apr 18.

Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan, China

Lan Zhu  1 , Nianqiao Gong  1 , Bin Liu  1 , Xia Lu  1 , Dong Chen  1 , Song Chen  1 , Hongge Shu  2 , Ke Ma  3 , Xizhen Xu  4 , Zhiliang Guo  5 , Enfeng Lu  6 , Dongrui Chen  7 , Qinggang Ge  8 , Junchao Cai  9 , Jipin Jiang  1 , Lai Wei  1 , Weijie Zhang  1 , Gang Chen  10 , Zhishui Chen  11
Affiliations

Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan, China

Lan Zhu et al. Eur Urol. 2020 Jun.

Abstract

Background: Previous studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations.

Objective: To evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients.

Design, setting, and participants: A total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group.

Intervention: Immunosuppressant reduction and low-dose methylprednisolone therapy.

Outcome measurements and statistical analysis: The clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis.

Results and limitations: The clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure.

Conclusions: Kidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations.

Patient summary: Immunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.

Keywords: Coronavirus disease 2019; Immunosuppression; Kidney transplantation; Outcome; Pneumonia.

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Figures

Fig. 1
Fig. 1
Serum creatinine changes in 10 post-transplant patients during the course of illness. (A) Six patients had renal graft damage. (B) Four patients had stable renal graft function.
Fig. 2
Fig. 2
Chest CT scans of 10 post-transplant patients. (A) A representative CT image of each patient: (a) patient 1: multiple bilateral subpleural patchy consolidation, prominent on the right; (b) patient 2: multiple bilateral reticular patterns, prominent on the right; (c) patient 3: multiple patchy ground-glass opacities bilaterally; (d) patient 4: multiple bilateral consolidation and ground-glass opacities in the right; (e) patient 5: multiple bilateral patchy consolidation; (f) patient 6: multiple subpleural patchy ground-glass opacities bilaterally; (g) patient 7: bilateral patchy ground-glass opacities; (h) patient 8: bilateral consolidation and patchy ground-glass opacity in the right side; (i) patient 9: multiple bilateral ground-glass opacities; and (j) patient 10: multiple bilateral patchy consolidation and ground-glass opacities. (B) Changes of chest CT images during the course of disease in a typical case (patient 3): (a and e) on illness day 3, multiple subpleural patchy ground-glass opacities bilaterally; (b and f) on illness day 7, much more ground-glass opacities and patchy consolidation bilaterally; (c and g) on illness day 16, multiple ground-glass opacities bilaterally with enlarged ranges; (d and f) on illness day 36, the lesion was almost completely absorbed, leaving only a few blurs. CT = computed tomography.
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