Supplementary Material for: First Reported Case in Romania of a Successfully Treated Severe COVID-19 in a Kidney Transplant Recipient: A Focus on Acute Kidney Injury

As coronavirus disease 2019 (COVID-19) caused by the novel virus SARS-CoV-2 is expanding worldwide, kidney involvement seems to be part of the spectrum of its effects. Moreover, the prognosis of the disease seems to be worse in immunocompromised patients when compared to the general population, with 4–5 times higher mortality rates. However, the overall impact on long-term function of the kidney graft is unknown. We report on a case of a 46-year-old kidney transplant recipient who was successfully treated for severe COVID-19 pneumonia. The clinical course was complicated by transient acute kidney injury, most likely due to tubulo-interstitial involvement, with return to the baseline of the creatinine level by the time of discharge. We discuss the characteristics and differential diagnosis of acute kidney injury, as well as management of immunosuppression in connection with overall clinical status and evolution of kidney function. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based, efficient COVID-19 therapy. The risk-benefit balance of the yet to be approved treatment strategies may be weighed differently in organ transplant recipients owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy.随着新型冠状病毒SARS-CoV-2引发的2019冠状病毒病（COVID-19）在全球范围内蔓延，肾脏受累似乎是该疾病病理谱中的表现之一。此外，与普通人群相比，免疫功能低下患者的该病预后更差，死亡率为普通人群的4至5倍。然而，其对肾移植受者移植物长期功能的整体影响尚不明确。本文报告1例46岁肾移植受者成功救治重症COVID-19肺炎的病例：患者病程中出现一过性急性肾损伤，其诱因极可能为肾小管间质受累，出院时肌酐水平已恢复至基线水平。本文同时讨论了急性肾损伤的临床特征与鉴别诊断，以及结合患者整体临床状态与肾功能变化制定免疫抑制治疗方案的策略。该病例阐明了在缺乏循证有效COVID-19治疗手段的情况下，移植领域专业人员可能面临的诊疗困境。由于器官移植受者存在免疫功能低下状态，且治疗药物可能与免疫抑制方案存在相互作用，因此对尚未获批的治疗策略进行风险-收益权衡时，需结合该群体的具体情况进行差异化考量。