Viral Presence and Immunopathology in a Kidney Transplant Recipient with Fatal COVID-19: A Clinical Autopsy Report

Coronavirus disease 2019 (COVID-19) is of special concern to immunocompromised individuals, including organ transplant recipients. However, the exact implications of COVID-19 for the immunocompromised host remain unclear. Existing theories regarding this matter are controversial and mainly based on clinical observations. Here, the post-mortem histopathology, immunopathology, and viral presence in various tissues of a kidney transplant recipient (KTR) with COVID-19 was compared to those of two non-transplanted patients with COVID-19 matched for age, sex, length of intensive care unit stay, and admission period in the pandemic. None of the tissues of KTR demonstrated the presence of SARS-CoV-2. In lung tissues of both controls some samples showed viral positivity with high Ct-values with qRT-PCR. The lungs of KTR and controls demonstrated similar pathology, consisting of acute fibrinous and organizing pneumonia with thrombosis and an inflammatory response with T-cells, B-cells, and macrophages. The kidney allograft and control kidneys showed a similar pattern of interstitial lymphoplasmacytic infiltration. No myocarditis could be observed in the hearts of KTR and controls, although all cases contained scattered lymphoplasmacytic infiltrates in the myocardium, pericardium, and atria. The brainstems of KTR and controls showed a similar pattern of lymphocytic inflammation with microgliosis.

This Research Report highlights the possibility that, based on the results obtained from this single case, at time of death the immune response in kidney transplant recipients with long-term anti-rejection immunosuppression use prior to severe illness is similar to non-transplanted deceased COVID-19 patients.