COVID-19 Infection in Children with Kidney Transplantation in Iran: A Case Series

Abstract

Introduction: Since mid-April 2020, infection with coronavirus disease of 2019 (COVID-19) has affected more than 2 million people worldwide. Little is known about the effects of COVID-19 infection on kidney transplant patients treated with immunosuppressive (IS) drugs. Case Presentation: Here, we report three Iranian pediatric kidney transplantation cases who acquired COVID-19 infection and were admitted to Hazrat Ali Asghar Hospital in Tehran, Iran, in March-April 2020 (first wave). They were treated with prednisolone, cyclosporine, and cellcept. All of them had gastrointestinal symptoms, and one patient also had respiratory symptoms. In two patients who had only gastrointestinal symptoms, chest radiographies were considered normal. They did not need the intensive care unit (ICU), ventilator respiratory support, and dialysis due to a temporary increase in serum creatinine and no change in urine volume. Cellcept was stopped and other medications continued. The patient, who had pulmonary and gastrointestinal symptoms, expressed more severe manifestations that led to ICU admission and dialysis. Prednisolone was increased to a stress dose and the other drugs were discontinued. Conclusions: Pulmonary manifestations significantly worsen the prognosis compared to gastrointestinal manifestations in pediatric kidney transplants with COVID-19.