Live donor kidney transplantation in a COVID 19 positive patient: case report and literature review

Introduction
Coronavirus disease 2019 [COVID-19] has become a pandemic resulting in a large number of deaths. The compl icat ions of COVID-19 are severe in post -transplantation patients on immunosuppression, resulting in more mortality. Therefore renal transplantations [KT] were  stopped temporarily in Sri Lanka during the peak of the COVID-19 epidemic. And a few months later when the KT was restarted only patients who were real-time polymerase chain reaction [PCR] test negative was accepted for KT. This case report describes a live donor KT done on a patient who recovered from COVID-19 infection but had persistently positive PCR test.

Case presentation
A 29-year-old male with end-stage renal failure due to chronic kidney disease of unknown aetiology underwent a live donor KT. He had COVID-19 infection more than 4 weeks before
the KT and was asymptomatic with normal chest X-ray [CXR] and white cell count [WBC]. But his PCR was positive. The donor was a 41-year-old male. The KT was done on 2nd February 2021. He had no significant postoperative complications.

Discussion and conclusions
The main diagnostic tests for COVID-19 infection are PCR and Rapid antigen tests. PCR detects the viral genomic RNA. It is known that patients who clinically recover from COVID-19 infection continue to excrete RNA particles. These are detected by PCR. Therefore it is suggested that if a patient clinically recovers from COVID-19 and has normal WBC, CXR and 6 weeks after the onset of initial infection can undergo KT safely despite having a positive PCR.