Severe COVID-19 in a renal transplant recipient: A focus on pharmacokinetics

Meziyerh, Soufian; Zwart, Tom C.; Etten, Ronald W van; Janson, J. A.; Gelder, Teun van; Alwayn, Ian P. J.; Fijter, Johan W. de; Reinders, Marlies E.J.; Moes, Dirk Jan A R; Vries, Aiko P. J. de

doi:10.1111/ajt.15943

Cited by 53 publications

(78 citation statements)

References 19 publications

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“…Although renal dysfunction as reflected by decreased eGFR or increased serum levels of creatinine was not considered in the published reports as a co-morbidity, it is important to recognize that renal dysfunction of kidney transplant recipients with COVID-19 ought to be recognized as such. Nevertheless, numerous reports that we reviewed showed that patients with a decreased eGFR plus other comorbidities 39 , 41 , 43 , 44 , 47 , 48 , 52 , 55 or increased serum levels of creatinine plus other comorbidities 36 , 38 , 40 , 42 , 46 , 53 , 54 still achieved a positive outcome. Interestingly, Sharma et al recently completed a retrospective study in which they compared the clinical outcomes of COVID-19 between solid organ transplant recipients and matched nontransplant patients in their medical center, and they found the need for renal replacement therapy in the organ recipients did not affect the incidence of severe COVID-19 and the rate of short-term death 70 .…”

Section: Discussionmentioning

confidence: 91%

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

Dayan¹,

Kersten²,

Battaglia³

et al. 2020

Int. J. Med. Sci.

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In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.

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Section: Discussionmentioning

confidence: 91%

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

Dayan¹,

Kersten²,

Battaglia³

et al. 2020

Int. J. Med. Sci.

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“…In this report, we describe the clinical courses and the outcomes For this reason and because of the interaction of ritonavir with CNI which could expose the patient to a persistent immunosuppressive state, 18,19 we withdraw antiviral therapy in the KTRs undergoing treatment and decided not to use antiviral therapy in the subsequent patients.…”

Section: Discussionmentioning

confidence: 99%

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

Maritati

Zuccatosta²,

Fiorentini

et al. 2020

Transplant Infectious Dis

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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.

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“…12,13 Another consideration is the potential interaction between antivirals such as lopinavir/ ritonavir and other investigational medications with immunosuppressives, mainly calcineurin and mammalian target of rapamycin inhibitors. 27 Immunosuppression dose adjustment and more frequent trough monitoring would be prudent in this case.…”

Section: Immunosuppression Managementmentioning

confidence: 93%

COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges

Jawdeh

2020

Advances in Chronic Kidney Disease

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The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.

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Severe COVID-19 in a renal transplant recipient: A focus on pharmacokinetics

Cited by 53 publications

References 19 publications

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

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

COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges

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