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 |
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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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