SARS‐CoV‐2 infection in kidney transplant recipients: Experience of the italian marche region

• Published in: Transplant infectious disease Vol. 22; no. 5; pp. e13377 - n/a
• Main Authors: Maritati, Federica, Cerutti, Elisabetta, Zuccatosta, Lina, Fiorentini, Alessandro, Finale, Carolina, Ficosecco, Marta, Cristiano, Fabrizio, Capestro, Alessandro, Balestra, Emilio, Taruscia, Domenica, Vivarelli, Marco, Donati, Abele, Perna, Gian Piero, Giacometti, Andrea, Tavio, Marcello, Onesta, Maicol, Di Sante, Laura, Ranghino, Andrea
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.10.2020; John Wiley and Sons Inc
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - immunology; Acute Kidney Injury - therapy; Aged; Antibodies, Monoclonal, Humanized - therapeutic use; Antimetabolites; Antiviral Agents - therapeutic use; Calcineurin; Calcineurin inhibitors; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - therapy; Cytosorb; Dimers; Drug Therapy, Combination; Extracorporeal Membrane Oxygenation; Female; Graft Rejection - immunology; Graft Rejection - prevention & control; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Immunocompromised Host; Immunomodulators; Immunosuppression; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Incidence; Infections; Inhibitors; Interleukins; Italy - epidemiology; kidney transplant; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Lung - diagnostic imaging; Male; Middle Aged; Monoclonal antibodies; Original Report; Original Reports; Oxygen; Oxygen - blood; Oxygen content; Oxygen saturation; Pandemics; Patients; Physicians; Renal Replacement Therapy; Respiration, Artificial; Respiratory diseases; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; SARS‐CoV‐2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Steroid hormones; Steroids; Time-to-Treatment; tocilizumab; Tomography, X-Ray Computed; TOR protein; Treatment Outcome; Viral diseases; Viruses; Italy; Cytosorb; kidney transplant; SARS-CoV-2; tocilizumab
• ISSN: 1398-2273; 1399-3062; 1399-3062
• DOI: 10.1111/tid.13377

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 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 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 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.