C T BACH1, V C HERON2, N E HOLMES3, O C SMIBERT3,4, J B WHITLAM2,5,6
1Department of General Medicine, Austin Health, Heidelberg, AUSTRALIA, 2Department of Nephrology, Austin Health, Heidelberg, AUSTRALIA, 3Department of Infectious Diseases, Austin Health, Heidelberg, AUSTRALIA, 4Department of Infectious Diseases and National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, AUSTRALIA, 5Department of Medicine, Austin Health, Heidelberg, AUSTRALIA, 6Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington, AUSTRALIA
Background: Novel coronavirus 2019 disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Initially discovered in China in 2019, it has since been declared a worldwide pandemic by the World Health Organisation. There have been limited reports of kidney-pancreas recipients with COVID-19, and the overall outcomes in this group of patients is unknown.
Case Report: A 45-year-old man with T3 paraplegia had undergone kidney-pancreas transplantation 18 years ago, followed by a subsequent kidney transplant 9 years ago, and presented with fevers, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma, and an elevated d-dimer were identified as established risk factors for severe COVID-19 disease. The medical history also included previous type 1 diabetes, EBV-associated post-transplant cerebral lymphoma that was treated with rituximab 9 years ago, BK and CMV viraemia. There were no proven COVID-19 specific therapies at the time and supportive management was provided. Oral prednisolone was increased, and baseline immunosuppression with everolimus was continued. A complete recovery was observed. We identify and review the potential mitigating roles of immunosuppression and mTOR-inhibitors in this disease.
Conclusions: This is one of few reported cases of COVID-19 in a kidney-pancreas transplant recipient. Despite multiple risk factors for severe disease, the outcome was favourable. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.
Cindy is a general medicine advanced trainee and will commence renal advanced training at Austin Health in 2021.