Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients

López, Verónica; Vazquez, Teresa; Alonso-Titos, Juana; Cabello, Mercedes; Alonso, Ángel; Beneyto, Isabel; Crespo, Marta; Díaz‐Corte, Carmen; Franco, Antônio; González-Roncero, F.M.; Gutiérrez, Elena; Guirado, Luís; Jiménez, Carlos; Jironda, Cristina; Lauzurica, Ricardo; Llorente, Santiago; Mazuecos, Auxiliadora; Paúl, Javier; Rodríguez‐Benot, Alberto; Ruiz, Juan Carlos; Sánchez‐Fructuoso, Ana; Sola, Eugenia; Torregrosa, Vicente; Zárraga, Sofía; Hernández, Domingo

doi:10.1016/j.nefroe.2020.03.017

Cited by 47 publications

(51 citation statements)

References 13 publications

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“…Interestingly, MPA inhibits SARS-CoV-2 replication in-vitro ( Han et al., 2020 ; Kato et al., 2020 ). This is in contrast with COVID-19 guidelines aimed at patients using immunosuppressive drugs for a pre-existing disease ( Lopez et al., 2020 ; British Transplantation Society, 2020 ; Société Francophone de Transplantation (SFT) SFdN et al., 2020 ). These expert-opinion-based guidelines recommend to discontinue MPA or reduce the MPA dose in patients with COVID-19.…”

Section: Discussionmentioning

confidence: 93%

Immunosuppressive Drugs and COVID-19: A Review

et al. 2020

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Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is currently unknown whether immunosuppressive drugs are advantageous or detrimental in patients with COVID-19. Immunosuppressive drugs could be harmful in the initial phase of COVID-19. In this phase, the host immune response is necessary to inhibit viral replication. However, immunosuppressive drugs might have a beneficial effect in the later, more severe phase of COVID-19. In this phase, an overshoot of the host immune response (the “cytokine storm”) can cause ARDS, multiorgan failure and mortality. Aim To summarize the available evidence on the effect of immunosuppressive drugs on infection with SARS-CoV-2. The effects of immunosuppressive drugs on similar pandemic coronaviruses may resemble the effects on SARS-CoV-2. Thus, we also included studies on the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) Methods The study protocol was registered in PROSPERO (registration number CRD42020181137). We included randomized controlled trials (RCTs), cohort studies with a control group and case-control studies concerning humans ≥ 18 years old. We also included in-vitro studies and animal studies with a control group. Results and Conclusion Sixty-nine studies were included. Interestingly, MPA inhibits SARS-CoV-2 replication in-vitro . Clinical studies are needed to confirm the inhibitory effect of MPA on SARS-CoV-2 replication in-vivo . There are indications that corticosteroids and IL-6 inhibitors, like tocilizumab, can reduce mortality and prevent mechanical ventilation in patients with COVID-19. However, observational studies have contradictory results and the risk of bias is high. Thus, these results have to be confirmed in high-quality clinical trials before these drugs can be implemented as standard care. Based on the positive results of CNIs, mTOR inhibitors and thiopurine analogues in in-vitro studies with SARS-CoV and MERS-CoV, it would be interesting to investigate their effects on SARS-CoV-2 replication.

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Section: Discussionmentioning

confidence: 93%

Immunosuppressive Drugs and COVID-19: A Review

et al. 2020

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“…In the last months, proposals for triage in several health conditions have been published especially in oncology including skin cancer. [4][5][6][7][8][9] BADO developed recommendations to prioritize dermato-oncological care on a national level in Belgium. In the circumstances of the COVID19 pandemic, the approval and refunding of tele/videoconsultations by the government was accelerated but for skin cancer treatment and follow-up teleconsultations are often suboptimal.…”

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confidence: 99%

Recommendations for skin cancer consultation and surgery during COVID‐19 pandemic

Brochez

Baurain

Marmol

et al. 2020

Acad Dermatol Venereol

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“…Two weeks after clinical and radiological recovery, the previous dose of tacrolimus and mycophenolate should be restarted stepwise. Currently, ongoing clinical trials are expected, where we can find more definite answers [44,57,58].…”

Section: Question 4: What Shall We Suggest To Kidney Transplant Recipmentioning

confidence: 99%

“…If patient does not have COVID-19, 250 mg IV corticosteroid followed by 1 mg/kg 3 days oral dose and tocilizumab should be used in cellular type acute rejection. In case of humoral rejection, IVIG, plasmapheresis, and tocilizumab are recommended treatment options, which are already used in the course of COVID-19 [41,[58][59][60]. Answer: The frequency of COVID-19 related AKI is not known at this time in kidney transplant patients.…”

Section: Question 4: What Shall We Suggest To Kidney Transplant Recipmentioning

confidence: 99%

COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?

et al. 2020

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Coronavirus disease 19 (COVID-19) became a nightmare for the world since December 2019. Although the disease affects people at any age; elderly patients and those with comorbidities were more affected. Everyday nephrologists see patients with hypertension, chronic kidney disease, maintenance dialysis treatment or kidney transplant who are also high-risk groups for the COVID-19. Beyond that, COVID-19 or severe acute respiratory syndrome (SARS) due to infection may directly affect kidney functions. This broad spectrum of COVID-19 influence on kidney patients and kidney functions obviously necessitate an up to date management policy for nephrological care. This review overviews and purifies recently published literature in a question to answer format for the practicing nephrologists that will often encounter COVID-19 and kidney related cases during the pandemic times.

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Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients

Cited by 47 publications

References 13 publications

Immunosuppressive Drugs and COVID-19: A Review

Immunosuppressive Drugs and COVID-19: A Review

Recommendations for skin cancer consultation and surgery during COVID‐19 pandemic

COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?

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