Dr Zhan Lim1, YUHAN GOH1, RUWANI RAJAPAKSA1, JAGADISH JAMBOTI1, RAMYASUDA SWAMINATHAN1, PETER BOAN2, ABU ABRAHAM1, ASHLEY IRISH1
1Department of Nephrology and Renal Transplant, Fiona Stanley Hospital, Perth, Australia, 2Departments of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Australia
Background: COVID-19 infection is associated with higher disease burden and mortality among kidney transplant recipients. In the immediate post-transplant period, there is limited evidence to guide changing immunosuppression to treat incidental COVID-19 infection. We present a patient who tested positive for SARS-CoV-2 within 24 hours following kidney transplantation.
Case Report: 42-year-old gentleman with end stage kidney disease secondary to IgA nephropathy on peritoneal dialysis presented for kidney transplantation via donation after circulatory death (DCD) pathway. He had received 3 doses of the BNT162b2 Pfizer vaccine. Pre-operative rapid antigen test (RAT) and polymerase chain reaction (PCR) test were negative for COVID-19. Serologic testing was negative for nucleocapsid protein IgG and showed high SARS-CoV-2 spike protein IgG titre (>8000 AU/mL). He received rabbit anti-thymocyte globulin (rATG) induction and underwent successful transplantation.
The patient tested positive for COVID-19 (RAT and PCR) on day +1 as part of close contact screening after his wife tested positive. He developed mild respiratory symptoms and was treated with molnupiravir and sotrovimab. To reduce risk of severe illness, third dose of rATG was withheld and mycophenolate dose was reduced. He was also treated with ceftriaxone and fluconazole for Klebsiella and Candida from donor’s urine culture. He was weaned off nasal oxygen by day +5 and discharged on day +7. Maintenance immunosuppression includes prednisolone 20mg daily, mycophenolate mofetil 1g b.d and tacrolimus targeted to trough of 5-8 ng/mL. The patient remains well with no residual signs of COVID-19 infection and good allograft function.
Conclusions: Our report illustrates the first case of peri-operative COVID-19 following kidney transplantation in Western Australia. Vaccination, antiviral, and monoclonal antibody treatment alongside immunosuppression reduction were able to prevent severe complications.
Biography:
Zhan is a first year nephrology advanced trainee at Fiona Stanley Hospital. He graduated from the University of Western Australia and completed his Postgraduate Diploma of Public Health at the University of Edinburgh with a focus on epidemiology of non-communicable diseases including chronic kidney disease.