94% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
CASE REPORT article
Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1521785
Management of concurrent severe COVID-19 pneumonia and antibody-mediated rejection following kidney transplantation: a case report
Provisionally accepted- Huazhong university of science and technology union hospital, Wuhan, China
Background: Due to its high mutation rate, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recurrently emerged worldwide in recent years, leading to an increased incidence of rejection following kidney transplantation and a worsened prognosis for recipients. The management of the concomitant occurrence of SARS-CoV-2 infection and rejection in kidney transplant recipients poses significant challenges, with limited available experience on this topic. This study presents a case report highlighting the simultaneous manifestation of severe corona virus disease 2019 (COVID-19) pneumonia and acute antibody-mediated rejection (ABMR) during the early post-transplantation period. Methods: The recipient underwent the renal transplantation from a deceased donor after brain death and received comprehensive management including antiviral therapy, adjustment of immunosuppressive medications, and relevant supportive care during the course of SARS-CoV-2 infection. In the overlapping period of severe COVID-19 pneumonia and ABMR, we implemented plasma exchange (PE) combined with intravenous immunoglobulin (IVIG) and rituximab treatment, while closely monitoring infection-related indicators and elucidate the impact of PE on SARS-CoV-2 antibodies. Results: The administration of PE did not significantly impact the level of SARS-CoV-2 IgG antibody. Meanwhile, the combination of PE, IVIG, and rituximab treatment effectively reversed ABMR without exacerbating SARS-CoV-2 infection. Conclusions: The timely administration of antiviral and anti-rejection therapies in the early stage of renal transplant recipient can lead to favorable outcome in case of SARS-CoV-2 infection and concurrent ABMR.
Keywords: ABMR, Kidney Transplantation, Pe, SARS-CoV-2, IVIg
Received: 02 Nov 2024; Accepted: 24 Feb 2025.
Copyright: © 2025 Xia, Li, Sun, Li and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xianpeng Zeng, Huazhong university of science and technology union hospital, Wuhan, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.