Search

Coronavirus disease (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection is still incompletely understood in transplantation, and there have been a few reports of multisystem inflammatory syndrome in adults (MIS-A) like illness in transplant patients. Herein, we report a case of MIS-A in a renal transplant that ultimately was successfully managed. The case was a 32-year-old man, transplanted 3 years ago, with chronic graft dysfunction and no other comorbidities. He presented with a 3-day history of fever and abdominal pain with no respiratory complaints. The patient had multi-organ involvement in the form of acute pancreatitis, severe diarrhea, acute kidney injury, and shock. Inflammatory markers including D-dimer and C-reactive protein were elevated. Chest radiology showed bilateral haziness on admission. The patient had two consecutive SARS CoV 2 reverse transcription–polymerase chain reaction (RT PCR) tests negative initially but eventually SARS CoV 2 antibody test came positive. The patient was managed initially with broad-spectrum antibiotics, and after confirmation of MIS-A, steroids, intravenous immunoglobulin, and anticoagulation were administered. The patient survived and was discharged on the 29th day of admission. Our reports highlight that MIS-A should be suspected in atypical cases irrespective of COVID-19 tests and should be confirmed with repeated RT-PCR and SARS-CoV-2 antibody tests.

Transplant in COVID era is a challenging task given a paucity of data and limited experience worldwide. A 35-year-old male patient with chronic kidney disease on dialysis for the past 9 months underwent successful living-related donor transplant with his father (aged 64 years) as donor at our center. In this case, donor was diagnosed with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 during evaluation, and he was managed with supportive care and comprehensive social distancing at home. Donor was asymptomatic throughout this period. Interval from positive to negative RT-PCR for nasopharyngeal swab test was 37 days. Interval from negative RT-PCR to kidney transplant was 33 days. Later, recipient and donor were discharged with negative RT-PCR posttransplant. At 71 days of follow-up, both recipient and donor have stable kidney function with normal urinalysis. Hence, prospective donor with a history of COVID-19 infection can be taken for transplant after thorough pretransplant evaluation and having two negative RT-PCR reports after infection, normal imaging, and additional preprocedural negative RT-PCR testing.