SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region.
Acute Kidney Injury
/ epidemiology
Aged
Antibodies, Monoclonal, Humanized
/ therapeutic use
Antiviral Agents
/ therapeutic use
COVID-19
/ diagnosis
Drug Therapy, Combination
Extracorporeal Membrane Oxygenation
Female
Graft Rejection
/ immunology
Humans
Hydroxychloroquine
/ therapeutic use
Immunocompromised Host
Immunosuppressive Agents
/ adverse effects
Incidence
Italy
/ epidemiology
Kidney Transplantation
/ adverse effects
Lung
/ diagnostic imaging
Male
Middle Aged
Oxygen
/ blood
Renal Replacement Therapy
Respiration, Artificial
SARS-CoV-2
/ immunology
Severity of Illness Index
Time-to-Treatment
Tomography, X-Ray Computed
Treatment Outcome
Cytosorb
SARS-CoV-2
kidney transplant
tocilizumab
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
17
05
2020
revised:
30
05
2020
accepted:
14
06
2020
pubmed:
24
6
2020
medline:
16
12
2020
entrez:
24
6
2020
Statut:
ppublish
Résumé
Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear. In this report, we describe the clinical data, the treatments, and the outcomes of 5 KTRs with SARS-CoV-2 admitted to our hospital in Ancona, Marche region, Italy, from March 17 to present. Due to the severity of SARS-CoV-2, immunosuppression with calcineurin inhibitors, antimetabolites, and mTOR-inhibitors were stopped at the admission. All KTRs were treated with low-dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose. Overall, the incidence of SARS-CoV-2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present, two patients died, two patients were discharged, and one is still inpatient in ICU. The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin-6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS-CoV-2-affected KTRs, a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase in the laboratory values such as D-dimer.
Sections du résumé
BACKGROUND
BACKGROUND
Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear.
METHODS
METHODS
In this report, we describe the clinical data, the treatments, and the outcomes of 5 KTRs with SARS-CoV-2 admitted to our hospital in Ancona, Marche region, Italy, from March 17 to present. Due to the severity of SARS-CoV-2, immunosuppression with calcineurin inhibitors, antimetabolites, and mTOR-inhibitors were stopped at the admission. All KTRs were treated with low-dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose.
RESULTS
RESULTS
Overall, the incidence of SARS-CoV-2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present, two patients died, two patients were discharged, and one is still inpatient in ICU.
CONCLUSIONS
CONCLUSIONS
The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin-6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS-CoV-2-affected KTRs, a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase in the laboratory values such as D-dimer.
Identifiants
pubmed: 32573895
doi: 10.1111/tid.13377
pmc: PMC7361066
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Antiviral Agents
0
Immunosuppressive Agents
0
Hydroxychloroquine
4QWG6N8QKH
tocilizumab
I031V2H011
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13377Informations de copyright
© 2020 Wiley Periodicals LLC.
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