Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center

Autor: Sandip Kapur, Samuel Sultan, Meredith J. Aull, Jun Lee, John R. Lee, Jehona Marku-Podvorica, Laura F Gingras, Stuart D. Saal, Darshana Dadhania, Manikkam Suthanthiran, Michelle Lubetzky, Thalia Salinas, Rebecca Craig-Schapiro, Thangamani Muthukumar, Choli Hartono, Rosy Priya Kodiyanplakkal
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Graft Rejection
Male
medicine.medical_treatment
030232 urology & nephrology
030230 surgery
0302 clinical medicine
Case fatality rate
Medicine
Enzyme Inhibitors
Kidney transplantation
Aged
80 and over
education.field_of_study
immunosuppression
Incidence
Acute kidney injury
Immunosuppression
Middle Aged
Allografts
Nephrology
Ambulatory
Female
Hemodialysis
Coronavirus Infections
Immunosuppressive Agents
Hydroxychloroquine
Adult
medicine.medical_specialty
Pneumonia
Viral
Population
kidney transplantation
Antimalarials
Betacoronavirus
03 medical and health sciences
Internal medicine
Humans
AcademicSubjects/MED00340
education
Pandemics
Aged
Retrospective Studies
Immunosuppression Therapy
Transplantation
SARS-CoV-2
business.industry
COVID-19
Original Articles
Mycophenolic Acid
medicine.disease
Transplant Recipients
Discontinuation
New York City
business
Zdroj: Nephrology Dialysis Transplantation
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/gfaa154
Popis: Background Kidney graft recipients receiving immunosuppressive therapy may be at heightened risk for coronavirus disease 2019 (Covid-19) and adverse outcomes. It is therefore important to characterize the clinical course and outcome of Covid-19 in this population and identify safe therapeutic strategies. Methods We performed a retrospective chart review of 73 adult kidney graft recipients evaluated for Covid-19 from 13 March to 20 April 2020. Primary outcomes included recovery from symptoms, acute kidney injury, graft failure and case fatality rate. Results Of the 73 patients screened, 54 tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—39 with moderate to severe symptoms requiring hospital admission and 15 with mild symptoms managed in the ambulatory setting. Hospitalized patients were more likely to be male, of Hispanic ethnicity and to have cardiovascular disease. In the hospitalized group, tacrolimus dosage was reduced in 46% of patients and mycophenolate mofetil (MMF) therapy was stopped in 61% of patients. None of the ambulatory patients had tacrolimus reduction or discontinuation of MMF. Azithromycin or doxycycline was prescribed at a similar rate among hospitalized and ambulatory patients (38% versus 40%). Hydroxychloroquine was prescribed in 79% of hospitalized patients. Graft failure requiring hemodialysis occurred in 3 of 39 hospitalized patients (8%) and 7 patients died, resulting in a case fatality rate of 13% among Covid-19-positive patients and 18% among hospitalized Covid-19-positive patients. Conclusions Data from our study suggest that a strategy of systematic triage to outpatient or inpatient care, early management of concurrent bacterial infections and judicious adjustment of immunosuppressive drugs rather than cessation is feasible in kidney transplant recipients with Covid-19.
Databáze: OpenAIRE
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