TABLE 1.
Summary of 4 cases of COVID-19 in solid organ transplant recipients
| Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
| Patient age | 54 | 67 | 53 | 74 |
| Transplanted organ | Kidney | Liver | Lung | Heart |
| Time posttransplant | 20 y | 19 y | 20 y | 23 y |
| Pertinent medical history | Chronic allograft dysfunction Hypertension Diabetes on insulin |
Cirrhosis of allograft | CLAD ESRD on peritoneal dialysis HFpEF |
Ulcerative colitis Cerebrovascular accident Obstructive sleep apnea Basal cell carcinoma of skin |
| Immunosuppressive medications | Tacrolimus (target level 5-10 ng/mL) Mycophenolate mofetil |
Cyclosporine (target level 100-150 ng/mL) | Cyclosporine (target level 100-150 ng/mL) Azathioprine Prednisone |
Tacrolimus (target level 4-6 ng/mL) Mesalamine |
| Fever | Documented | Subjective | None reported | Subjective |
| Symptoms | Fatigue Dry cough and dyspnea Nausea and vomiting Diarrhea |
Fatigue Increased confusion Dry cough Diarrhea |
Fatigue Dry cough and dyspnea |
Sore throat Dry cough |
| White blood cell count (thousands/microL) | 6.23 | 1.93 | 3.94 | Not performed |
| Absolute lymphocyte count (thousands/microL) | Admission: 1.98 Nadir: 0.87 |
0.9 | 0.16 | Not performed |
| Creatinine (mg/dL) | Baseline: 1.9 Admission: 3.43 Peak: 5.19 Discharge: 3.59 Follow-up: 2.85 |
Baseline: 1.3 Admission/Peak: 1.7 Discharge: 1.3 |
Peritoneal dialysis patient | Not performed |
| Urinalysis | Specific gravity 1.011 g/mL Protein 4+ Occult Blood 1+ RBCs 3-5 per hpf |
Not performed | Not performed | Not performed |
| Aspartate aminotransferase and alanine aminotransferase | 48 (mild elevation) and 34 (normal) | 39 and 12 (normal) | 20 and 17 (normal) | Not performed |
| Cardiac troponin (ng/mL) | <0.03 | <0.04 | Not performed | Not performed |
| SARS-CoV-2 test results | Illness day 4: Positive Illness day 16: Positive Illness day 22: Negative Illness day 39: Negative |
Illness day 5: Positive | Illness day 5: Inconclusive (RT-PCR at University internal laboratory) Illness day 5: Positive (RT-PCR at State Public Health Laboratory) |
Illness day 2: Positive |
| Additional respiratory virus test results | Influenza A/B: Negative Extended respiratory viral panel: Negativea |
Influenza A/B: Negative Extended respiratory viral panel: Negativea |
Influenza A/B: Negative Extended respiratory viral panel: Negativea |
Influenza A/B: Negative Extended respiratory viral panel: Negativea |
| Chest X-ray findings | Illness day 1: No new abnormalities Illness day 3: Subtle lobar opacity Illness day 8: Multifocal infiltrates |
No new abnormalities | No new abnormalities | Not performed |
| Outcome | Hospitalized 13 d Discharged home Symptoms resolved |
Hospitalized 6 d Discharged home Symptoms resolved |
Supportive care at home Symptoms resolved |
Supportive care at home Symptoms resolved |
| Days of follow-up from initial test | 43 | 41 | 34 | 32 |
Abbreviations: CKD, chronic kidney disease; CLAD, chronic lung allograft dysfunction; CXR, chest X-ray; ESRD, end-stage renal disease; HFpEF, heart failure with preserved ejection fraction; hpf, high powered field; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; RT-PCR, real-time polymerase chain reaction.
Extended respiratory viral panel is performed at University of Washington Virology Laboratory. The panel tests for bocavirus, human metapneumovirus, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, influenza A, influenza B, commonly circulating non-SARS-CoV-2 coronaviruses, rhinovirus, and adenovirus, using RT-PCR.