Chikobava Elisabed, Chkhikvadze Lasha, Menabde Keti, Pkhakadze Giorgi, Tchokhonelidze Irma
Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO.
Department of Nephrology, High Technology Medical Center Hospital, Tbilisi, GEO.
Cureus. 2024 Jan 29;16(1):e53163. doi: 10.7759/cureus.53163. eCollection 2024 Jan.
The coronavirus disease 2019 (COVID)-19 pandemic significantly affected transplantation care strategies due to the heightened vulnerability of transplant recipients to severe illness. We present a unique case of a 31-year-old female with COVID-19 pneumonia following a recent kidney transplant managed with immunosuppressant reduction and tocilizumab therapy. The patient underwent live donor kidney transplantation and was considered a low immunologic risk recipient. Following surgery, she presented with fever, headache, and fatigue, and subsequent testing confirmed active COVID-19 infection. Imaging revealed characteristic pneumonia features. Standard approaches, including immunosuppressant reduction and antibiotic therapy, initially failed to halt clinical deterioration. Progressive radiological findings and increasing inflammatory markers raised concerns of impending graft failure and cytokine storm. Considering the severity of the condition, tocilizumab, an interleukin-6 (IL-6) receptor antagonist, was administered alongside continued supportive care and adjusted immunosuppression. Within a day post-tocilizumab infusion, the patient showed significant improvement in clinical parameters, with resolution of respiratory distress and systemic symptoms. Laboratory markers gradually normalized, and subsequent lung imaging showed improvement. The patient was discharged with follow-up recommendations. Managing COVID-19 in postoperative transplant patients requires nuanced approaches due to immunosuppression-related complexities. Despite limited guidance, our case highlights the successful use of tocilizumab in treating COVID-19 pneumonia shortly after transplantation, showcasing its potential effectiveness and safety in this context. Reporting such experiences is crucial for refining management strategies for immunocompromised transplant recipients facing COVID-19 complications.
2019冠状病毒病（COVID-19）大流行对移植护理策略产生了重大影响，因为移植受者更容易患重病。我们报告了一例独特的病例，一名31岁女性在近期肾移植后发生COVID-19肺炎，通过减少免疫抑制剂和使用托珠单抗治疗。该患者接受了活体供肾移植，被认为是低免疫风险受者。术后，她出现发热、头痛和疲劳，随后检测证实为活动性COVID-19感染。影像学检查显示出典型的肺炎特征。包括减少免疫抑制剂和抗生素治疗在内的标准方法最初未能阻止临床恶化。影像学表现逐渐进展以及炎症标志物升高引发了对移植即将失败和细胞因子风暴的担忧。考虑到病情的严重性，在持续的支持治疗和调整免疫抑制的同时，给予了白细胞介素-6（IL-6）受体拮抗剂托珠单抗。在输注托珠单抗后的一天内，患者的临床参数有显著改善，呼吸窘迫和全身症状得到缓解。实验室指标逐渐恢复正常，随后肺部影像学检查显示有所改善。患者出院时给出了随访建议。由于免疫抑制相关的复杂性，术后移植患者的COVID-19管理需要细致入微的方法。尽管指导有限，但我们的病例突出了托珠单抗在移植后不久治疗COVID-19肺炎方面的成功应用，展示了其在这种情况下的潜在有效性和安全性。报告此类经验对于完善面临COVID-19并发症的免疫功能低下移植受者的管理策略至关重要。
