COVID-19 in Kidney Transplant Recipient With Concomitant Burn Injury: A Challenge to Balance Immunosuppression

Abstract

The COVID-19 pandemic has grossly affected the transplant communities with no exception to any geographic area. Burn injury remains an important public health problem, even during the pandemic. The management of concomitant burn in an organ transplant recipient has been rarely described. Here, we report a kidney transplant recipient who was admitted for moderate COVID-19 symptoms and then sustained a second-degree inhalational burn injury at home on day 2 after discharge from COVID-19. The patient was shown to be COVID-19 positive and was isolated initially in the burn unit. After a second negative report on day 3 of hospital admission, the patient was shifted to the general ward. He required a hemodialysis session and modification of immunosuppression, which was done through telemedicine from our center. The wound was complicated by a rejection episode, which was treated by regrafting. He recovered on day 45 after injury with baseline immunosuppression restored. His serum creatinine reached a nadir of 3.2 mg/dL, and he has continued on regular follow-up. In summary, our case highlights the difficulty in managing burn cases during the pandemic. The added problem of balancing immunosuppression in organ transplant recipients with burn injuries is a daunting task for transplant physicians.