Abstract

This case describes successful renal transplantation in an elderly patient following diagnosis with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Forty-six days prior to transplant, a 65-year-old African American Male with end stage renal disease on kidney transplant waitlist, hypertension, hyperlipidemia, and chronic diastolic heart failure presented to the emergency department and was diagnosed with SARS-CoV-2 pneumonia. Following treatment with dexamethasone and convalescent plasma therapy during the two-week inpatient admission, the patient was discharged home. Subsequently, the patient was reactivated on waitlist following two confirmatory negative SARS-CoV-2 PCR tests. Upon the transplant admission, repeat PCR and rapid antigen tests resulted negative. The patient received anti-thymocyte globulin 4.5 mg/kg as induction therapy. Post-operative course was uneventful with immediate graft function. Maintenance therapy included tacrolimus, mycophenolate, and corticosteroid taper. A SARS-CoV-2 IgG antibody test collected during the admission resulted positive. The patient was discharged on post-operative day 4 with a serum creatinine of 1.6 mg/dL. At 2 month following transplant, the patient remains asymptomatic with stable renal function. In this case report, the patient safely received T-cell depleting induction therapy following SAR-CoV-2 pneumonia. Positive SARS-CoV-2 antibodies at the time of transplant may have provided protection against recurrent infection.

Keywords: Kidney transplantation; Serum creatinine; Antibiotics; lymphopenia; Tacrolimus