Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients

Abstract

Coronavirus disease 2019 (COVID-19) is a novel and highly contagious disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and patients with comorbidities and immunosuppressive conditions may experience severe signs and symptoms that can lead to death. This case series assesses the clinical course, imaging features, and outcomes for 12 patients with COVID-19 and a history of kidney transplantation. Patients were evaluated for symptoms, laboratory data, imaging findings, and outcomes from February 2020 to April 2020. Fever, cough, and dyspnea were the most common clinical symptoms, noted in 75% (nine/12), 75% (nine/12), and 41.7% (five/12) of the patients, respectively. Most of the patients had a normal white blood cell count, while 33.3% (four/12) had leukopenia and 8.3% (one/12) had leukocytosis. A combination of consolidation and ground glass opacity was the most predominant (75%) pattern of lung involvement on computed tomography (CT). Eight patients died of severe COVID-19 pneumonia and acute respiratory distress syndrome and four were discharged. All recovered cases had a unilateral peripheral pattern of involvement limited to only one zone on initial chest CT. It seems that CT imaging has an important role in predicting COVID-19 outcomes for solid organ transplant recipients. Future studies with long-term follow up and more cases are needed to elucidate COVID-19 diagnosis, outcome, and management strategies for these patients.

Keywords: COVID-19; Computed tomography; Disease attributes; Immunocompromised; Kidney transplantation.

Fig. 1

A 38-yr-old male patient presented with a dry cough and dyspnea and a history of kidney transplantation 15 yr previously. Computed tomography images show bilateral peripheral ground glass opacity (thin arrows) on the anterior side and an area of bilateral consolidation with air bronchogram (wide arrows) on the posterior side, predominantly in the lower lobes. Incidental pneumomediastinum is noted (thick-headed arrows). The patient died after 22 d in hospital.

Fig. 2

A 49-yr-old woman presented with a dry cough, sore throat, headache, and a history of kidney transplantation 17 yr previously. (A,B) Computed tomography (CT) images obtained 3 d after the onset of symptoms show patchy ground-glass opacity in the right inferior lobe with slight central consolidation (long arrows). (C,D) CT images obtained 25 d after the onset of symptoms with secondary superimposed bacterial pneumonia show diffuse bilateral ground-glass opacity and consolidation with air bronchogram (wide arrows) predominantly in the upper lobes and bilateral mild plural effusion (thick-headed arrows). (E,F) CT images obtained 28 d after the onset of symptoms and intravenous antibiotic therapy show evolution of the area of consolidation with vacuolar signs (small black arrows) in the right upper lobe and fibrotic bands (long arrow) in the right lower lobe. The patient was discharged after 37 d.