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

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

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.

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • Betacoronavirus / drug effects*
  • Betacoronavirus / immunology
  • Betacoronavirus / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • China
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / virology
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Humans
  • Immunocompromised Host*
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Male
  • Methylprednisolone / administration & dosage*
  • Methylprednisolone / adverse effects
  • Middle Aged
  • Noninvasive Ventilation
  • Opportunistic Infections / drug therapy*
  • Opportunistic Infections / mortality
  • Opportunistic Infections / therapy
  • Opportunistic Infections / virology
  • Oxygen Inhalation Therapy
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / virology
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index
  • Time Factors
  • Transplant Recipients*
  • Treatment Outcome
  • Virus Shedding
  • Young Adult

Substances

  • Antiviral Agents
  • Glucocorticoids
  • Immunosuppressive Agents
  • Methylprednisolone

Supplementary concepts

  • COVID-19 drug treatment