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Case report
Complete recovery from COVID-19 of a kidney-pancreas transplant recipient: potential benefit from everolimus?
  1. Vanessa C Heron1,
  2. Cindy-Anne T Bach2,
  3. Natasha E Holmes3 and
  4. John B Whitlam1,4
  1. 1Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
  2. 2Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
  3. 3Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
  4. 4Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr John B Whitlam; john.whitlam{at}austin.org.au

Abstract

We present a kidney-pancreas transplant recipient who achieved complete recovery from COVID-19. A 45-year-old patient with T3 paraplegia underwent kidney-pancreas transplantation 18 years ago, followed by a subsequent kidney transplant 9 years ago, and presented with fever, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma and an elevated D-dimer were identified as established risk factors for severe COVID-19. Supportive management was provided, baseline immunosuppression with everolimus was continued, and oral prednisolone was increased. A complete recovery was observed. Given the favourable outcome despite risk factors for severe COVID-19, we identify and review the potential mitigating roles of immunosuppression and mammalian target of rapamycin (mTOR) inhibitors in this disease. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.

  • renal transplantation
  • drugs: infectious diseases

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-238413

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    Footnotes

    • Contributors All authors contributed to the preparation of this article. They were involved in conception and design, drafting and revising the article, and final approval of the version published. They agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.