Korean J Transplant.  2022 Nov;36(Supple 1):S172. 10.4285/ATW2022.F-2981.

Deep venous thrombosis in deceased donor kidney transplant recipient infected with COVID-19

• Burog A
• Mejes MA

• KMID: 2535688
• DOI: http://doi.org/10.4285/ATW2022.F-2981

Abstract

Kidney transplant recipients remain a vulnerable population for COVID-19 due to their immunosuppressive state and usual concomitant co-morbidities. Like the general population, they commonly present with fever, cough, dyspnea and diarrhea. However, COVID-19 can also cause profound coagulopathy which if unidentified and untreated can lead to morbidity. There has been limited reports on the incidence and management of thromboembolic events in kidney transplant recipient infected with COVID-19. We present a case of a 36-year-old male who underwent deceased donor kidney transplantation with delayed graft function. At day 6 post-op he developed fever, loose stool and cough and tested positive for COVID-19 infection. Chest computed tomography scan revealed reticular densities in both lower lungs and blood test showed leukocytosis and elevated CRP and procalcitonin. On day 18 post-op, he developed swelling of the right lower extremity. D-dimer was elevated and dop-pler ultrasound showed venous thrombosis of the right external iliac vein, right common and superficial femoral vein. Medical management included, heparin bolus and enoxaparin, immunosuppression adjustment using low dose CNI and mycophenolic acid, Remdesivir and IV antibiotics. The patient was COVID-19 recovered after 13 days of treatment. Medical management was continued and there was recovery from delayed graft function and gradual resolution of leg swelling. On day 41 post-op, the patient was discharged, off-dialysis, recovered from delayed graft function with decreasing swelling of the right lower extremity. Home medications included Apixaban 5 mg tablet twice a day for the next 3 months. Follow-up ultrasound at 3 months post-op showed resolution of venous thrombosis and serum creatinine at its nadir at 1.19 mg/dL. Risk for thromboembolism is higher among kidney transplant recipients than general population and COVID-19 infection is another recently identified sig-nificant contributory risk factor. There should be higher index of suspicion and intensified thrombosis prophylaxis among this population.