Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

Link to article at PubMed

Clin Kidney J. 2021 Jan 29;14(4):1229-1235. doi: 10.1093/ckj/sfab025. eCollection 2021 Apr.

ABSTRACT

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RESULTS: At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent.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.

PMID:34282376 | PMC:PMC7929031 | DOI:10.1093/ckj/sfab025

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