Use of remdesivir in kidney transplant recipients with SARS-CoV-2 Omicron infection

Cacho, Judit; Nicolás, David; Bodro, Marta; Cuadrado, Elena; Torres-Jaramillo, Verónica; Gonzalez-Rojas, Ángela; Ventura‐Aguiar, Pedro; Herrera, Sabina; Rico, Verónica; Cofán, Frederic; Oppenheimer, F.; Revuelta, Ignacio; Diekmann, Fritz; Cucchiari, David

doi:10.1016/j.kint.2022.08.001

Cited by 12 publications

(6 citation statements)

References 7 publications

(15 reference statements)

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“…Two studies in our review reporting on the clinical course of Omicron infections in KTRs found alarming hospital admission rates between 16 and 50%. Further studies in KTRs [68,69] and other solid organ transplant recipients (SOTRs) support similar event rates, for example, a hospital admission rate of 16% was found for lung-transplanted patients in a nationwide German study [70,71]. As in our analysis the few participants with severe disease had low or absent immune responses, additional vaccine doses can provide efficient [72] protection from severe disease once a sufficient serologic response is reached.…”

Section: Discussionsupporting

confidence: 78%

Effectiveness, Immunogenicity and Harms of Additional SARS-CoV-2 Vaccine Doses in Kidney Transplant Recipients: A Systematic Review

et al. 2023

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Background: Kidney transplant recipients (KTRs) who have a highly impaired immune response are in need of intensified and safe vaccination strategies to achieve seroconversion and prevent severe disease. Methods: We searched the Web of Science Core Collection, the Cochrane COVID-19 Study Register and the WHO COVID-19 global literature on coronavirus disease from January 2020 to 22 July 2022 for prospective studies that assessed immunogenicity and efficacy after three or more SARS-CoV-2 vaccine doses. Results: In 37 studies on 3429 patients, de novo seroconversion after three and four vaccine doses ranged from 32 to 60% and 25 to 37%. Variant-specific neutralization was 59 to 70% for Delta and 12 to 52% for Omicron. Severe disease after infection was rarely reported but all concerned KTRs lacked immune responses after vaccination. Studies investigating the clinical course of COVID-19 found remarkably higher rates of severe disease than in the general population. Serious adverse events and acute graft rejections were very rare. Substantial heterogeneity between the studies limited their comparability and summary. Conclusion: Additional SARS-CoV-2 vaccine doses are potent and safe in general terms as well as regarding transplant-specific outcomes whilst the Omicron wave remains a significant threat to KTRs without adequate immune responses.

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Section: Discussionsupporting

confidence: 78%

Effectiveness, Immunogenicity and Harms of Additional SARS-CoV-2 Vaccine Doses in Kidney Transplant Recipients: A Systematic Review

et al. 2023

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“…One study of SOTRs hospitalized with SARS-CoV2 infection found that severe COVID-19 cases show high mortality despite antiviral treatment with RDV[ 11 ]. Another cohort study found that remdesivir protected KTRs from severe COVID-19 disease only in those hospitalized with early administration of the drug (within 7 days of symptom onset)[ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

Zona,

Gibes,

Jain

et al. 2024

World J Virol

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BACKGROUND Kidney transplant recipients (KTR) are at risk of severe coronavirus disease 2019 (COVID-19) disease and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We predicted that hospitalization for COVID-19 and subsequent admission to the intensive care unit (ICU) would yield worse outcomes in KTRs. AIM To investigate outcomes among KTRs hospitalized at our high-volume transplant center either on the general hospital floor or the ICU. METHODS We retrospectively describe all adult KTRs who were hospitalized at our center with their first SARS-CoV-2 infection between 04/2020 and 04/2022 and had at least 12 months follow-up (unless they experienced graft failure or death). The cohort was stratified by ICU admission. Outcomes of interest included risk factors for ICU admission and mortality, length of stay (LOS), respiratory symptoms at admission, all-cause graft failure at the last follow-up, and death related to COVID-19. RESULTS 96 KTRs were hospitalized for SARS-COV-2 infection. 21 (22%) required ICU admission. The ICU group had longer hospital LOS (21.8 vs 8.6 days, P < 0.001) and were more likely to experience graft failure (81% vs 31%, P < 0.001). Of those admitted to the ICU, 76% had death at last-follow up, and 71% had death related to COVID-19. Risk factors for ICU admission included male sex (aHR: 3.11, 95%CI: 1.04-9.34; P = 0.04). Risk factors for all-cause mortality and COVID-19-related mortality included ICU admission and advanced age at SARS-CoV-2 diagnosis. Mortality was highest within a month of COVID-19 diagnosis, with the ICU group having increased risk of all-cause (aHR: 11.2, 95%CI: 5.11-24.5; P < 0.001) and COVID-19-related mortality (aHR: 27.2, 95%CI: 8.69-84.9; P < 0.001). CONCLUSION ICU admission conferred an increased risk of mortality, graft failure, and longer LOS. One-fifth of those hospitalized died of COVID-19, reflecting the impact of COVID-19-related morbidity and mortality among KTRs.

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“…The subsequent cohort study found that in the remdesivir-treated cohort of patients with the Omicron variant, severe illness could only be avoided by taking the drug early (within ≤7 days of symptom onset), and if the drug was administered correctly during the viremia phase of the disease, it was effective. Cacho et al ( 70 ) also noted that remdesivir could be safely administered to KTRs with eGFR <30 mL/min. Therefore, remdesivir is an important and viable treatment option for KTRs diagnosed with the Omicron variant.…”

Section: Application Of Antiviral Drugs In Renal Transplant Patients ...mentioning

confidence: 98%

Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19

Zheng,

Sun,

et al. 2024

Front. Med.

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The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 posed a massive threat to human life and caused an economic upheaval worldwide. Kidney transplant recipients (KTRs) became susceptible to infection during the COVID-19 pandemic owing to their use of immunosuppressants, resulting in increased hospitalization and mortality rates. Although the current epidemic situation is alleviated, the long-term existence of COVID-19 still seriously threatens the life and health of KTRs with low immunity. The Omicron variant, a highly infectious but less-pathogenic strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns among transplant physicians regarding managing KTRs diagnosed with this variant. However, currently, there are no clear and unified guidelines for caring for KTRs infected with this variant. Therefore, we aimed to summarize the ongoing research on drugs that can treat Omicron variant infections in KTRs and explore the potential of adjusting immunotherapy strategies to enhance their responsiveness to vaccines. Herein, we discuss the situation of KTRs since the emergence of COVID-19 and focus on various prevention and treatment strategies for KTRs since the Omicron variant outbreak. We hope to assist physicians in managing KTRs in the presence of long-term COVID-19 variants.

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Use of remdesivir in kidney transplant recipients with SARS-CoV-2 Omicron infection

Cited by 12 publications

References 7 publications

Effectiveness, Immunogenicity and Harms of Additional SARS-CoV-2 Vaccine Doses in Kidney Transplant Recipients: A Systematic Review

Effectiveness, Immunogenicity and Harms of Additional SARS-CoV-2 Vaccine Doses in Kidney Transplant Recipients: A Systematic Review

Long-term follow-up of kidney transplant recipients admitted to a tertiary care transplant center with SARS-CoV-2

Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19

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