COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul.

Publisher: Munksgaard Country of Publication: Denmark NLM ID: 100883688 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3062 (Electronic) Linking ISSN: 13982273 NLM ISO Abbreviation: Transpl Infect Dis Subsets: MEDLINE

Original Publication: Copenhagen : Munksgaard, c1999-

COVID-19/*therapy ; Immunosuppression Therapy/*standards ; Immunosuppressive Agents/*adverse effects ; Kidney Transplantation/*adverse effects ; SARS-CoV-2/*immunology; Adult ; Aged ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antiviral Agents/therapeutic use ; COVID-19/diagnosis ; COVID-19/immunology ; COVID-19 Nucleic Acid Testing ; Critical Care/methods ; Critical Care/standards ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination/methods ; Drug Therapy, Combination/standards ; Female ; Follow-Up Studies ; Graft Rejection/immunology ; Graft Rejection/prevention & control ; Humans ; Immunosuppression Therapy/adverse effects ; Immunosuppression Therapy/methods ; Immunosuppressive Agents/administration & dosage ; Intensive Care Units/standards ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Male ; Middle Aged ; Patient Admission/standards ; Practice Guidelines as Topic ; Respiration, Artificial/standards ; Retrospective Studies ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Severity of Illness Index ; Transplant Recipients ; Treatment Outcome ; Turkey

Introduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19.
Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation.
Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up.
Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.
(© 2020 Wiley Periodicals LLC.)

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Keywords: COVID-19; acute kidney injury; adult; antiviral agents; cytokine release syndrome; cytokine-targeted therapy; kidney transplantation; respiratory distress syndrome

0 (Antibodies, Monoclonal, Humanized)
0 (Antiviral Agents)
0 (Immunosuppressive Agents)
0 (Interleukin 1 Receptor Antagonist Protein)
I031V2H011 (tocilizumab)

Date Created: 20200714 Date Completed: 20201215 Latest Revision: 20220731

20221213

PMC7404438

10.1111/tid.13371

32657540