*Purpose: Several cases have demonstrated positive SARS-CoV-2 PCR testing in patients who were initially shown to have cleared the infection. These reinfections may represent new strains of SARS-CoV-2 that can have significant clinical implications in the transplant population and affect public health initiatives aimed at controlling this pandemic. The purpose of this case is to highlight the presentation of COVID-19 reinfection in a kidney transplant recipient.

*Methods: We present a 66-year-old male patient with a history of ESRD due to lithium toxicity, status post deceased donor kidney transplant, maintained on Belatacept, prednisone and mycophenolate mofetil. He was first diagnosed with COVID-19 in March 2020 after presenting with cough, fever and hypoxia. Chest x-ray revealed bilateral infiltrates. Treatment included atazanavir, hydroxychloroquine and tocilizumab. Mycophenolate was withheld for the duration of his treatment. Despite resolution of all symptoms, nasopharyngeal PCR testing remained positive for SARS-CoV-2 even on discharge. He subsequently cleared his infection and tested negative twice, 3 months apart. He was later found to have AKI and a biopsy showed Banff 2A Acute Cellular Rejection which was treated with steroids and thymoglobulin. He was readmitted in November with fatigue and shortness of breath and tested positive again for SARS-CoV-2 by nasopharyngeal swab PCR. There was no hypoxia and chest x-ray did not show any infiltrates. Prerenal azotemia resolved with IV hydration. Serological studies showed presence of SARS-CoV2 IgG antibodies. Mycophenolate was again held. There was concern that this could be prolonged intermittent shedding from his previous infection. However genetic sequencing from samples of his first and current infection were compared and revealed a different strain consistent with a new infection. He recovered and was discharged.

*Results: COVID-19 reinfection in the transplant population is of significant interest as these patients may be susceptible to prolonged recovery. Several points of interest can be derived from this case. Firstly, the clinical significance of different viral strains and its effect on vaccination efforts may provide significant public health information. Second, the utility and importance of SARS-COV2 antibody testing may provide insight into the course of reinfection and degree of protection conferred by antibodies thereby providing guidance about the appropriate management of immunosuppression. Our patient had SARS-CoV-2 antibodies and his mild course allowed us to re-institute his immunosuppression early. Lastly, the potential for reinfection may necessitate continued testing and protective measures beyond vaccination efforts.

*Conclusions: To the best of our knowledge this is the first reported case of COVID-19 reinfection in a kidney transplant recipient with a different viral strain confirmed by genetic sequencing.

« Back to 2021 American Transplant Congress