Managing COVID‐19 in Renal Transplant Recipients: A Review of Recent Literature and Case Supporting Corticosteroid‐sparing Immunosuppression

Johnson, Kristen; Belfer, Julie J.; Peterson, Gina R.; Boelkins, Mark; Dumkow, Lisa E.

doi:10.1002/phar.2410

Cited by 88 publications

(103 citation statements)

References 22 publications

(82 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, compared to hospitalized cohort of nontransplant patients, Pereira et al demonstrated a higher rate of severe diseases and mortality in transplant patients 10 . In order to enable a more efficient antiviral immunity, immunosuppressive treatment was discontinued or significantly reduced in the majority of the published case reports 11,12 . On the other hand, opposite data suggesting immune dysregulation as underlying cause of severe COVID‐19 manifestations have been reported 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Johnson et al reported in their review on 3 patients who remained on triple calcineurin inhibitor (CNI)‐based immunosuppressive therapy 4,11,14 . All 3 patients showed uncomplicated clinical course with stable graft function during the infection and COVID‐19 convalescence within a short period of time 11 …”

Section: Discussionmentioning

confidence: 99%

“…Taken together, a variety of clinical case reports demonstrated different approaches for the adjustment of immunosuppression leading to a different outcome. Despite the differences in details, the majority of patients received corticosteroid monotherapy, and in only a few cases the maintenance immunosuppression was not changed 11 . However, outside of supportive care, the optimal management of immunosuppression in transplant recipients with COVID‐19 remains largely uncertain.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Immune monitoring facilitates the clinical decision in multifocal COVID-19 of a pancreas-kidney transplant patient

Babel

Anft

Blázquez-Navarro

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

The optimal management in transplant recipients with coronavirus disease 2019 (COVID‐19) remains uncertain. The main concern is the ability of immunosuppressed patients to generate sufficient immunity for antiviral protection. Here, we report on immune monitoring facilitating a successful outcome of severe severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐associated pneumonia, meningoencephalitis, gastroenteritis, and acute kidney and pancreas graft failure in a pancreas‐kidney transplant recipient. Despite the very low numbers of circulating B, NK, and T cells identified in follow‐up, a strong SARS‐CoV‐2 reactive T cell response was observed. Importantly, we detected T cells reactive to Spike, Membrane, and Nucleocapsid proteins of SARS‐CoV‐2 with majority of T cells showing polyfunctional proinflammatory Th1 phenotype at all analyzed time points. Antibodies against Spike protein were also detected with increasing titers in follow‐up. Neutralization tests confirmed their antiviral protection. A correlation between cellular and humoral immunity was observed underscoring the specificity of demonstrated data. We conclude that analyzing the kinetics of nonspecific and SARS‐CoV‐2‐reactive cellular and humoral immunity can facilitate the clinical decision on immunosuppression adjustment and allow successful outcome as demonstrated in the current clinical case. Although the antiviral protection of the detected SARS‐CoV‐2‐reactive T cells requires further evaluation, our data prove an ability mounting a strong SARS‐CoV‐2‐reactive T cell response with functional capacity in immunosuppressed patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Immune monitoring facilitates the clinical decision in multifocal COVID-19 of a pancreas-kidney transplant patient

Babel

Anft

Blázquez-Navarro

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Tocilizumab (and other IL-6 blockers) has been tried with variable success in KTRs with moderate-severe disease or in patients with high IL-6 levels. 50 Whether additional immunosuppression with IL-6 blockade would provide increased benefit in immunosuppressed KTRs is controversial and a subject of ongoing research. It is contraindicated in patients with a suspected or proven coinfection with bacterial or fungal agents and it should be individualized in KTRs in which benefits outweigh the risks.…”

Section: Managementmentioning

confidence: 99%

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

Kataria

Yakubu

Winstead

et al. 2020

Transplantation Direct

View full text Add to dashboard Cite

The novel severe acute respiratory syndrome coronavirus 2 was identified in the late 2019 as the cause of coronavirus disease 2019 (COVID-19), an acute respiratory viral illness. Patients with chronic underlying conditions may have an increased risk of morbidity and mortality from COVID-19. Kidney transplant recipients may be at a uniquely increased risk of serious complications from COVID-19 as compared to the general population because of a chronically immunosuppressed state and a high prevalence of comorbidities like diabetes, heart disease, and lung disease. Early data suggest that the mortality of patients on dialysis may be comparable to those with kidney transplants, although more research is needed. This concise review aims to describe the epidemiology of COVID-19 in kidney transplant recipients, manifestations, appropriate management, and clinical outcomes based on the available literature. Current evidence on many of the specific antiviral measures against COVID-19 has not shown a clear-cut benefit in smaller studies and the results of several ongoing larger clinical trials are awaited. In addition, we also highlight the impact of COVID-19 on kidney transplant center practice and volumes; potential living or deceased donors, recipients; and induction immunosuppression and surgical strategies.

show abstract

“…Since the rst case with SARS-CoV-2 was published in December 2019, the laboratory-con rmed cases are continuously escalating day to day and spread like wild re to more than 200 countries and territories [5,6]. COVID-19 cases are frequently associated with respiratory and multiorgan dysfunction that result in deaths [7][8][9][10]. Accordingly, the use of antiviral drugs in patients with this disease have triggered questions and whether currently antiviral drugs could be effectively cured this disease prompts a critical consideration.…”

Section: Introductionmentioning

confidence: 99%

Comparative therapeutic efficacy of interferon and combination Kaletra plus interferon alpha-2b against SARS-CoV-2

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The outbreak of coronavirus disease 2019 (COVID-19) posed an enormous threat to public health. The use of antiviral drugs in patients with this disease have triggered people’s attentions. Whether interferon alfa-2b or Kaletra plus interferon alfa-2b treatment can against SARS-CoV-2 was unknown.Methods: This is a retrospective cohort study of 123 laboratory-confirmed COVID-19 patients between Jan.13 2020 and Apr. 23. All patients received standard supportive care and regular clinical monitoring, patients were assigned to standard care group (n=12), interferon alfa-2b group (n=44), and combination Kaletra plus interferon alfa-2b group (n=67) according to their therapies. The primary endpoint for this study was the duration of oxygen-support requirement and virus clearance time. The associations of therapies with these outcomes were assessed by Cox proportional hazards regression. Results: Baseline clinical and laboratory characteristics were similar among 3 groups (p＞0.05). There was no significant association of Kaletra /interferon alfa-2b with faster SARS-CoV-2 RNA clearance (HR, 0.85 [95% CI, 0.45–1.61]; P = 0.61 in interferon alfa-2b group vs HR, 0.59 [95% CI, 0.32–1.11]; P = 0.10 in Kaletra plus interferon alfa-2b group). The duration of oxygen-support requirement in therapy groups similarly showed no significant association. There were no differences among 3 groups in the incidence of adverse events (p＞0.05).Conclusions: In patients with confirmed SARS-CoV-2 infection, no benefit was observed with interferon alfa-2b and Kaletra plus interferon alfa-2b treatment beyond standard care. Further trials in appropriately randomized design may contribute to validate the effective role and safety profile of the test drugs.

show abstract

Managing COVID‐19 in Renal Transplant Recipients: A Review of Recent Literature and Case Supporting Corticosteroid‐sparing Immunosuppression

Cited by 88 publications

References 22 publications

Immune monitoring facilitates the clinical decision in multifocal COVID-19 of a pancreas-kidney transplant patient

Immune monitoring facilitates the clinical decision in multifocal COVID-19 of a pancreas-kidney transplant patient

COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice

Comparative therapeutic efficacy of interferon and combination Kaletra plus interferon alpha-2b against SARS-CoV-2

Contact Info

Product

Resources

About