SAFE CONVERSION FROM BELATACEPT TO CICLOSPORIN IN A RENAL TRANSPLANT PATIENT WITH COVID-19 PNEUMONIA

Introduction: Immunocompromised patients may be at increased risk for complications of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection Although data of SARS-CoV-2 infection in solid organ transplant (SOT) recipients on calcineurin inhibitors are emerging, less is known about the course of COVID-19 pneumonia in SOT patients receiving costimulatory blockade as maintenance immunosuppression Methods: We present a case report of a 62 year old female renal transplant recipient with COVID-19 pneumonia who was safely switched from belatacept to ciclosporin while suffering from the disease Results: The patient presented with fever, shortness of breath and weakness at the end of March Because she had typical symptoms, she was tested for SARS-CoV-2 The test was positive and she was subsequently admitted to our hospital because of worsening dyspnea Chest X-ray showed infiltrates Since the diagnosis was established and she was stable with nasal O2 supplementation and not needing ventilatory support, a CT scan was not performed Due to multiple infectious complications, she did not receive MPA Her next dose of belatacept was due during her first days in hospital, however she was still complaining about shortness of breath Instead of treating her with reduced dose of belatacept, we decided to switch her to low dose ciclosporin in order to be able to stop immunosuppression in case of respiratory deterioration The prednisone dose of 5 mg remained unchanged However, she recovered without specific therapy After three weeks the two throat gargle samples were negative Antibody testing revealed weak presence of SARS-CoV-2 antibodies Conclusion: Taken together, the presented case shows a mild course of COVID-19 pneumonia in a patient on belatacept immunosuppression In this case, the switch to ciclosporin was well tolerated and did not change the course of COVID-19 disease We plan to re-introduce belatacept after 8 weeks after full recovery Further analysis is warranted whether remaining on costimulatory blockade is safe during COVID-19 pneumonia