A new disease due to Coronavirus (COVID-19)
Coronavirus (COVID-19) has spread rapidly across the world; almost all people are directly or indirectly exposed to an infection risk of Corona Virus. Since December 2019, the novel Coronavirus (SARS-CoV-2) has spread from a single city in Hubei, China to most of the world.
Coronavirus (COVID-19) in the patients of kidney transplantation
It is therefore not surprising that Coronavirus (COVID-19) has been identified in kidney transplant recipients. Dr Vinay Nair from New York presents his first ten cases of confirmed COVID-19 in kidney transplant recipients in his healthcare network.
This is a small cohort. It is clear that Coronavirus (COVID-19) can exist in different ways, similar to the general population, and the prognosis for individual recipients of kidney transplants patients can vary widely. However, overall mortality is high in these cases.
Affect os Coronavirus (COVID-19) in the general population
Similar to the general population suffering from Coronavirus (COVID-19), myalgia, fever, and cough were the most common symptoms.
Most patients had evidence of viral pneumonia, which was on CXR or CT investigation. The severity of the disease during the presentation was also found very different.
We found that one patient of Coronavirus (COVID-19) was urgently endotracheal intubated and brought to the intensive care unit while another patient of Coronavirus (COVID-19) was discharged home. Unfortunately, several patients of kidney transplant in the hospital are decompensated. Out of the 5 intensive care patients, 3 were initially admitted to a medical department. Three of the five intensive care patients eventually died, which is in line with the poor prognosis of patients who need intensive care in the general population in the study of Dr Vinay Nair.
In comparison, a study from Wuhan China we found 54% of the total population of patients with ARDS have died.
A study from the China patients with Coronavirus (COVID-19) kidney transplant recipients, mortality did not report in five patients with non-“severe” infections.
Another report from Italy among transplant recipients with Coronavirus (COVID-19) described an overall mortality rate in admitted patients of 25%. We need larger studies to fully understand the mortality risk of transplant recipients with Coronavirus (COVID-19)
The World Health Organization (WHO) Recommendations
The World Health Organization (WHO) has classified the resulting Coronavirus (COVID-19) as a global pandemic.
The recent Chinese experience with Coronavirus (COVID-19) has addressed the clinical features of the virus, including risk factors and prognoses in the general population.
However, there is little information about the infectious course of Coronavirus (COVID-19) in immunocompromised individuals, including kidney transplant recipients. Because of their decreased T cell immunity, transplant recipients are expected to be at higher risk of serious bacterial and viral infections.
This would indicate that kidney transplant recipients are at higher risk of infection and mortality from Coronavirus (COVID-19). However, very few reports of COVID-19 have been published in transplant recipients. Coronavirus (COVID-19) infected patient with kidney transplant recipient may suffer gastrointestinal symptoms (GI), fever and pulmonary findings within 48 hours. The patient tested positive for COVID-19 having 12 years after the kidney transplant and who recovered after treatment with reduced immunosuppression and low-dose methylprednisolone. So far it is unclear whether these are isolated cases or whether a tempered immune response is helpful to prevent a severe cytokine storm in connection with Coronavirus (COVID-19)-induced acute respiratory distress syndrome (ARDS).
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