Post‐mortem molecular investigations of SARS‐CoV‐2 in an unexpected death of a recent kidney transplant recipient

Solid organ transplant recipients are vulnerable to severe infection during induction therapy. We report a case of a 67‐year‐old male who died unexpectedly 10 days after receiving a kidney transplant on February 10, 2020. There was no clear cause of death, but COVID‐19 was considered retrospectively, as the death occurred shortly after the first confirmed case of COVID‐19 in Canada. We confirmed the presence of SARS‐CoV‐2 components in the renal allograft and native lung tissue using immunohistochemistry for SARS‐CoV‐2 spike protein and RNA scope in situ hybridization for SARS‐CoV‐2 RNA. Results were reaffirmed with the Food and Drug Administration Emergency Use Authorization approved Bio‐Rad SARS‐CoV‐2 digital droplet PCR for the kidney specimen. Our case highlights the importance of patient autopsies in an unfolding global pandemic and demonstrates the utility of molecular assays to diagnose SARS‐CoV‐2 post‐mortem. SARS‐CoV‐2 infection during induction therapy may portend a fatal clinical outcome. We also suggest COVID‐19 may be transmittable via renal transplant. This study uses unconventional molecular techniques, including digital droplet polymerase chain reaction and RNA scope, to identify COVID‐19 as the cause of death for a recent kidney transplant recipient.