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By mid-2020, most of the world was grappling with the millions of deaths caused by the COVID-19 pandemic. In this context, Uruguay was an outlier, managing the situation with remarkable success 1. By this time, convalescent plasma (CP) therapy had been proposed as an effective alternative for the treatment of severe cases 2. Solid organ transplant recipients and patients with underlying kidney disease represent a vulnerable population at high risk for adverse outcomes from COVID-19. These populations may develop more aggressive disease, yet they have been excluded or underrepresented in many clinical trials. There are randomized clinical trials suggesting that CP administration may be useful in patients with some types of immunodeficiency 3. The aim of this study was to follow a two-time renal transplant patient with severe COVID-19 treated with convalescent plasma over time from an immunologic and virologic perspective. Case report: A 42-year-old female patient, who was a two-time kidney transplant recipient, was hospitalized with COVID-19. Due to worsening respiratory symptoms, she was admitted to the intensive care unit, where she was orotracheally intubated with ventilatory support. At that time, she received two doses of convalescent plasma.
She had a favorable clinical course and was discharged 31 days after the onset of the symptoms.
Nasopharyngeal swab (NS), saliva, tracheal aspirate (TA), and serum samples were collected from the patient before, during, and after treatment with CP. Viral RNA was extracted using a QIAamp® Viral RNA Mini Kit. Detection of SARS-CoV-2 was performed with the national “COVID-19 RT-PCR Real TM Fast-HEX/Cy5 Kit” (ATGen, Institut Pasteur de Montevideo, Universidad de la República, Montevideo, Uruguay). Anti-RBD (Wuhan variant) IgG serum levels were quantified using the COVID-19 IgG ELISA kit (developed by the Universidad de la República, Institut Pasteur de Montevideo, and ATGen SRL). The concentration of IFN-g, IL-6, (C) IL-8, (D) IL-10, and (E) MCP- 1 were measured by LEGENDplexTM Human Inflammation Panel 1.
A significant decrease in viral load after PC treatment was observed in saliva and nasopharyngeal swab samples, and a slight decrease in viral load in tracheal aspirate samples. In addition, an increase in antibody titers was observed after PC transfusion. Figure 1.
During the COVID-19 pandemic, before vaccines and antiviral drugs became available, PC was widely used at various stages of the disease. Most studies evaluating the use of PC in patients with severe COVID-19 infection have not shown benefit 4. However, these reports do not focus on immunosuppressed patients. In this clinical case, we hipothetized that CP infusion may have induced increased neutralizing antibodies as well as significantly decreased levels of several cytokines. These findings are particularly relevant for developing countries where access to antivirals, monoclonal antibody therapy or other treatment options is limited. These therapies represent a simple option for COVID-19 infection and other future emerging viral infections.