Use of tocilizumab in kidney transplant recipients with COVID-19

Autor: Perez-Saez M, Blasco M, Redondo-Pachon D, Ventura-Aguiar P, Bada-Bosch T, Perez-Flores I, Melilli E, Sanchez-Camara L, Lopez-Oliva M, Canal C, Shabaka A, Garra-Moncau N, Martin-Moreno P, Lopez V, Hernandez-Gallego R, Siverio O, Galeano C, Espi-Reig J, Cabezas C, Rodrigo M, Llinas-Mallol L, Fernandez-Reyes M, Cruzado-Vega L, Perez-Tamajon L, Santana-Estupinan R, Ruiz-Fuentes M, Tabernero G, Zarraga S, Ruiz J, Gutierrez-Dalmau A, Mazuecos A, Sanchez-Alvarez E, Crespo M, Pascual J, Spanish Soc Nephrology COVID-19 Gr
Rok vydání: 2020
Předmět:
Graft Rejection
Male
kidney transplantation/nephrology
Comorbidity
Gastroenterology
law.invention
chemistry.chemical_compound
infection and infectious agents ‐ viral
Randomized controlled trial
law
Immunology and Allergy
Pharmacology (medical)
education.field_of_study
Mortality rate
Incidence
Hazard ratio
Middle Aged
practice
clinical research/practice
infection and infectious agents - viral
kidney transplantation/nephrology
patient survival
Treatment Outcome
Female
Cohort study
Adult
medicine.medical_specialty
infection and infectious agents - viral
Population
nephrology
kidney transplantation
Brief Communication
clinical research/practice
Antibodies
Monoclonal
Humanized
Young Adult
Tocilizumab
patient survival
Internal medicine
medicine
Humans
education
Pandemics
Retrospective Studies
Transplantation
business.industry
SARS-CoV-2
COVID-19
medicine.disease
Kidney Transplantation
Confidence interval
chemistry
clinical research
Spain
business
Cytokine storm
Follow-Up Studies
Zdroj: AMERICAN JOURNAL OF TRANSPLANTATION
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
American Journal of Transplantation
r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
ISSN: 1600-6135
Popis: Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.
Databáze: OpenAIRE
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