Abstract
Background: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. The clinical picture of transplant recipients and the effect of the anti-rejection immunosuppressive regimens on the clinical course of COVID-19 are lacking.Case presentation: We report two cases of COVID-19infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stableclinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reducedimmunosuppressiontherapy and finally recovered.Conclusions: We report COVID-19 infectionin two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference valuefor treating such patients. Additional data are needed to gain a better understanding of the impact of immunosuppressive therapy on the clinical presentation, severity, and outcome of COVID-19in solid organ transplant recipients.