Protracted COVID-19 pneumonitis early post-ABO incompatible kidney transplantation: Management considerations and the role of whole genome sequencing

Sara Stoler; Sebastiaan J van Hal; Steve Chadban; Thomas Le; Paul Torzillo; Rose-Marie Scarlato; Kate Wyburn; Griffith B Perkins; Tina Marinelli

doi:10.1111/nep.14235

Protracted COVID-19 pneumonitis early post-ABO incompatible kidney transplantation: Management considerations and the role of whole genome sequencing

Nephrology (Carlton). 2023 Nov;28(11):639-643. doi: 10.1111/nep.14235. Epub 2023 Aug 27.

Authors

Sara Stoler¹, Sebastiaan J van Hal^{2

3}, Steve Chadban^{1

3

4}, Thomas Le², Paul Torzillo^{3

5}, Rose-Marie Scarlato¹, Kate Wyburn^{1

3

4}, Griffith B Perkins^{6

7

8}, Tina Marinelli²

Affiliations

¹ Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
² Department of Infectious Diseases and Microbiology, Royal Prince Alfred, Sydney, New South Wales, Australia.
³ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁷ Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Immunology Directorate, SA Pathology, Adelaide, South Australia, Australia.

PMID: 37635271
DOI: 10.1111/nep.14235

Abstract

We present the case of a recent ABO incompatible kidney transplant recipient with persistent SARS-CoV-2 infection and pneumonitis. Serial whole genome sequencing confirmed intra-host viral evolution, which was used as a surrogate to confirm active viral replication and support re-treatment with antivirals, late in the course of infection. A prolonged course of remdesivir combined with immunosuppression modulation resulted in successful clearance of virus and clinical improvement. The diagnostic process undertaken in this case provides a useful guide for other clinicians when approaching similar patients.

Keywords: ABO incompatible; COVID-19; antiviral; kidney transplant; pneumonitis.

Publication types

Case Reports

MeSH terms

ABO Blood-Group System
Antiviral Agents / therapeutic use
Blood Group Incompatibility
COVID-19* / diagnosis
Graft Rejection
Humans
Immunosuppression Therapy
Kidney Transplantation* / adverse effects
Kidney Transplantation* / methods
Male
Middle Aged
Pneumonia* / drug therapy
SARS-CoV-2 / genetics

Substances

ABO Blood-Group System
Antiviral Agents