Persistence of SARS-CoV-2 Virus in a Kidney Transplant Recipient
Mohamed A, Prashar R, Alangaden G, Malinzak L, Denny J, Delvecchio K, and Kim D. Persistence of SARS-CoV-2 Virus in a Kidney Transplant Recipient. Am J Transplant 2021; 21(SUPPL 1):46.
Am J Transplant
Background: We are now discovering the sequelae of the novel coronavirus disease (COVID-19) as they relate to the transplant population. Questions regarding duration of viral shedding, infectivity, and reinfection remain. We present the case of a kidney transplant recipient who had COVID-19 prior to transplantation. The patient had presumably cleared the infection, but subsequently tested positive after transplantation.
Case: A 30-year-old female with chronic kidney disease secondary to IgA nephropathy was found to be suitable for a living related kidney transplant. Shortly after her evaluation, before her surgery, she developed symptoms of SARS-CoV-2 virus, and was found to be positive via PCR. She presumably cleared her infection as evidenced by negative PCR testing, two weeks after cessation of symptoms. She underwent robotic-assisted living-related kidney transplantation with basiliximab induction. She developed a postoperative hematoma that required operative evacuation. Thus, she was tested for the virus prior to reoperation, and found to be positive-83 days following symptom onset. She remained asymptomatic by this point. She also tested positive for SARS-CoV-2 IgG antibodies.
Conclusion: This case illustrates the persistence of SARS-CoV-2 virus and highlights the potential for viral replication after initiation of immunosuppression. It also highlights the possibility of prolonged viral shedding, beyond the maximum reported timeframe. Depletion of T cells from immunosuppression may explain the persistent viral replication and shedding. The clinical significance of prolonged viral shedding in transplant patients remains undefined. The timing of clearance for transplantation, role of retesting after transplantation, and management of immunosuppression are questions that need to be investigated.