Korean J Transplant.  2022 Nov;36(Supple 1):S382. 10.4285/ATW2022.F-5218.

Clinical manifestations of delayed COVID-19 pneumonia in kidney transplant recipients

• Ahn JM
• Ryu T
• Kim H
• Oh J
• Kim J

• KMID: 2535222
• DOI: http://doi.org/10.4285/ATW2022.F-5218

Abstract

From January to April 2022, during the secondary wave of COVID-19 (Omicron) in Korea, the Korean government mandated 7 days of quarantine for COVID-19 patients. Most patients complained of mild symptoms during the quarantine period and re-turned to their daily lives after that period. In our hospital, we identified 126 COVID-19 infections in kidney transplant recipients through their contact. We observed the delayed pattern of COVID-19 pneumonia in 11 (8.7%) kidney transplant patients after the legal isolation period. There were nine (72.7%) women, median ages were 66 years (range, 60–79) and median time after renal transplantation was 3.4 years (range, 0.4–29.3). There were eight cases of living donor kidney transplantation and two cases of ABO blood type incompatible kidney transplantation. Most of the immunosuppressants were administered steroids, tacrolimus, and mycophenolate. Half of the patients had diabetes. All patients were vaccinated against COVID-19 more than twice. The pa-tient was hospitalized for a median of 14 days (range, 9–26) after confirmed COVID-19 infection, and the total length of hospi-talization was a median of 8 days (range, 6–36). Among the patients, 63.6% of dyspnea, 36.3% of fever, and 81.8% of respiratory symptoms were observed. During hospitalization, maintenance dialysis was started in two patients, and acute renal failure was observed in three patients. One confirmed an increase in FK-506 related to Paxlovid administration, but two had an increase in FK-506 for unknown reasons. All patients were given steroids and antibiotics, and nine (81.8%) were given remdesivir. Two patients completely stopped immunosuppressants during hospitalization, and 7 (63.6%) patients stopped mycophenolate. In COVID-19 infection, delayed patterns of pneumonia are more frequent in kidney transplant recipients than in the general popu-lation. Even after the general course of infection, according to his symptoms and CT ratio of PCR, the patient should be considered for additional administration of antiviral drugs.