Introduction: The severity of covid-19 infection in transplant patients is much high when compared to general population. There is still limited data among different organ transplants and their management strategies with covid -19 infection. This is the first reported literature from India about covid infection in simultaneous pancreas kidney transplant patients.
Methods and Results: This is the first case series in Asia describing covid infection among simultaneous pancreatic and kidney transplant recipients. This is a retrospective study of five patients who underwent simultaneous pancreas and kidney transplant with basic disease of diabetes mellitus type 1 who contracted covid -19 infection during the pandemic. All five patients will be separately discussed in the detailed case series report. All patients were covid RT-PCR positive. Management was similar to the treatment strategies employed as for kidney only recipients because of lack of conclusive date during the pandemic. Mycophenolate was withheld in 4 patients (80%) and reduced to half dose in one patient. Oral prednisolone was changed to intravenous hydrocortisone/dexamethasone for the patients who required hospital admission (60%). Two patients had covid infection in the immediate postoperative period (40%), complicating hospital course and recovery. In two patients needed supplemental oxygen. Out of five patients, one had mortality due to severe sepsis and multiorgan failure. Graft function of both kidney and pancreas was stable in 4/5 patients even in the follow up period. The follow up period of these patients were complicated by infections (4/4) in the follow up period, although the graft function was stable.


Conclusion: Limited literature regarding management of covid-19 infection among simultaneous pancreatic kidney transplant exists. The treatment plan should always be individualised based on clinical, laboratory and imaging parameters in toto. The follow up period is crucial as there are high chances of opportunistic infections. This case series may help as a source of information in how to handle delicate scenarios as in simultaneous pancreatic kidney transplants and may provide insights to further studies.