Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

Background Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Methods Herein, we report the fol...

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Bibliographic Details
Published in:Clinical Kidney Journal 2021-04, Vol.14 (4), p.1229-1235
Main Authors: Anton Pampols, Paula, Trujillo, Hernando, Melilli, Edoardo, Urban, Blanca, Sandino, Justo, Favá, Alexandre, Gutierrez, Eduardo, Bestard, Oriol, Mancebo, Esther, Sevillano, Angel, Cruzado, Josep M, Morales, Enrique
Format: Article
Language:English
Subjects:
Antibodies
Antiviral agents
Coronaviruses
Health aspects
Immunosuppressive agents
Immunotherapy
Kidneys
Mortality
Organ transplant recipients
Original
Spain
Transplantation
Viral antibodies
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Summary:Background Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Methods Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units, who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. Results At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes or de novo donor-specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. Conclusions Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized. Graphical Abstract
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfab025