Renal involvement in COVID-19: focus on kidney transplant sector

Abstract

Introduction Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. Materials and Methods The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. Conclusion This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.

mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study

“…Regarding the therapeutic management of the infection, the first step was the reduction of immunosuppressive therapy, providing, in the first instance, the reduction or suspension of antimetabolites. In the case of severe forms of the disease, all immunosuppressive therapy was suspended, except for the steroid therapy, which was increased (OR for modification/suspension of immunosuppressive therapy vs. non-modification of immunosuppressive therapy in SOT with a moderate-severe form of COVID-19:0.7, 95, CI: (0.44-0.85), p = 0.048) (18)(19)(20)(21). Only one patient experienced acute organ rejection, and two patients died.…”

Piperacillin/Tazobactam and Meropenem Use Increases the Risks for Acute Graft Rejection Following First Kidney Transplantation

“…Since only 18% of our patients received living donor kidneys, the number did not allow us to investigate any potential interaction between the use of PM and the method of graft harvesting, although a previous systemic review in living donor kidney transplant did not find any significant difference in the graft outcome between using laparoscopic donor nephrectomy and robot-assisted laparoscopic donor nephrectomy [ 32 ]. Not unlike a previous review paper that highlighted the impact of COVID-19 infection on the kidney transplant activity and the development of acute renal failure [ 33 ], the number of patients in our cohort was dramatically reduced in 2020, the last of the five years of activity we have included in our study. Data on any other viral infections also were not captured.…”

The Impact of Direct Oral Anticoagulant Prophylaxis for Thromboembolism in Thrombophilic Patients Undergoing Abdominoplastic Surgery

“…The direct oral anticoagulants have been successfully employed in treatment of DVT in patients affected by thrombophilia [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Rivaroxaban can be orally administered for VTE prevention for hip or knee replacement surgery showing postoperative bleeding rates like enoxaparin [ 64 , 65 , 66 , 67 ].…”

“…The direct oral anticoagulants have been successfully employed in treatment of DVT in patients affected by thrombophilia [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Rivaroxaban can be orally administered for VTE prevention for hip or knee replacement surgery showing postoperative bleeding rates like enoxaparin [ 64 , 65 , 66 , 67 ]. The main advantage of direct oral anticoagulants, such as rivaroxaban, is their predictability in pharmacokinetic and pharmacodynamic profiles, not requiring a continuous laboratory monitoring and leading to a simplify dosing regimens well tolerated by patients [ 33 ].…”