ABSTRACT
We present the case of a recent ABO incompatible kidney transplant recipient with persistent SARS-CoV-2 infection and pneumonitis. Serial whole genome sequencing confirmed intra-host viral evolution, which was used as a surrogate to confirm active viral replication and support re-treatment with antivirals, late in the course of infection. A prolonged course of remdesivir combined with immunosuppression modulation resulted in successful clearance of virus and clinical improvement. The diagnostic process undertaken in this case provides a useful guide for other clinicians when approaching similar patients.
Subject(s)
COVID-19 , Kidney Transplantation , Pneumonia , Humans , ABO Blood-Group System , Blood Group Incompatibility , COVID-19/diagnosis , Graft Rejection , Immunosuppression Therapy , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , SARS-CoV-2/genetics , Male , Middle Aged , Antiviral Agents/therapeutic use , Pneumonia/drug therapyABSTRACT
Kidney transplantation offers patients with end stage kidney disease the best outcomes. Concentration on nutrition is pivotal throughout the transplant life course. Nutritional requirements change during each phase of transplantation, from pretransplant evaluation and wait-time, acute transplantation, maintenance and ultimately declining graft function, and care should be taken to consider each stage. In this article we concentrate on addressing each phase, with additional focus on current hot topics of dysglycaemia management and on the impact of diet on gut microbiome.