Allogeneic kidney transplantation after COVID-19: A case report

Kijima, Yu; Shimizu, Tomokazu; Sekido, Eri; Kato, Shinya; Kano, Kana; Toguchi, Makoto; Horiuchi, Toshihide; Nozaki, Taiji; Omoto, Kazuya; Inui, Masashi; Toma, Hiroshi; Iida, Shoichi; Takagi, Toshio

Background Patients undergoing organ transplantation are immunosuppressed and already at risk of various diseases. We report about a patient who underwent ABO-incompatible kidney transplantation following coronavirus disease (COVID-19) without a recurrence of infection. Case report A 68-year-old woman presented with end-stage renal failure due to primary autosomal dominant polycystic kidney disease; accordingly, hemodialysis was initiated in September 2020. Her medical history included bilateral osteoarthritis, lumbar spinal stenosis, hypertension, and hyperuricemia. In mid-January 2021, she contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from her husband. Both of them were hospitalized and received conservative treatment. Since their symptoms were mild, they were discharged after 10 days. The patient subsequently underwent ABO-incompatible kidney transplantation from her husband who recovered from COVID-19 in March 2021. Before kidney transplantation, her COVID-19 polymerase chain reaction test was negative, confirming the absence of pre-existing COVID-19 immediately before the procedure. Computed tomography revealed no pneumonia. Initial immunosuppression was induced by administering tacrolimus, mycophenolate mofetil, methylprednisolone, basiliximab, rituximab, and 30 g intravenous immunoglobulin. Double-filtration plasmapheresis and plasma exchange were performed once before ABO-incompatible kidney transplantation. The renal allograft functioned immediately, and the postoperative course was normal without rejection. COVID-19 did not recur. In addition, her serum creatinine levels and renal function had otherwise remained stable. Conclusion Living kidney transplantation was safely performed in a patient with COVID-19 without postoperative complications or rejection. During the COVID-19 pandemic, the possibility of SARS-CoV-2 infection during transplantation surgery must be considered.