Abstract
Kidney transplant recipients are at high risk of developing severe COVID-19 due to the coexistence of several transplant-related comorbidities (e.g., cardiovascular disease, diabetes) and chronic immunosuppression. As a consequence, a large part of SARS-CoV-2 infected patients have been managed with a reduction of immunosuppression. The mTOR-I, together with antimetabolites, have been often discontinued in order to minimize the risk of pulmonary toxicity and to antagonize pharmacological interaction with antiviral/anti-inflammatory drugs. However, at our opinion, this therapeutic strategy, although justified in kidney transplant recipients with severe COVID-19, should be carefully evaluated in asymptomatic/paucisymptomatic patients in order to avoid the onset of acute allograft rejections, to potentially exploit the mTOR-I antiviral properties, to reduce proliferation of conventional T lymphocytes (which could mitigate the cytokine storm) and to preserve Treg growth/activity which could reduce the risk of progression to severe disease. In this review, we discuss the current literature regarding the therapeutic potential of mTOR-Is in kidney transplant recipients with COVID-19 with a focus on pulmonary fibrosis.
Highlights
Reviewed by: Naoka Murakami, Brigham and Women’s Hospital and Harvard Medical School, United States Martin H De Borst, University Medical Center Groningen, Netherlands Jan-Luuk Hillebrands, University Medical Center Groningen, Specialty section: This article was submitted to
At our opinion, this therapeutic strategy, justified in kidney transplant recipients with severe COVID-19, should be carefully evaluated in asymptomatic/paucisymptomatic patients in order to avoid the onset of acute allograft rejections, to potentially exploit the mammalian target of rapamycin inhibitors (mTOR-Is) antiviral properties, to reduce proliferation of conventional T lymphocytes and to preserve Treg growth/activity which could reduce the risk of progression to severe disease
We discuss the current literature regarding the therapeutic potential of mTOR-Is in kidney transplant recipients with COVID-19 with a focus on pulmonary fibrosis
Summary
49/210 SOT (23.3%) 108 kidney transplant recipients 14/230 SOT (6.1%) 162 kidney transplant recipients 6/53 (11.3%). 26 (33.8%) only MMF or mTOR-I withdrawal 43 (55.8%) both CNI and MMF or mTOR-I withdrawal mTOR-I was decreased or stopped in 35/ 49 (71.4%) mTOR-I was decreased or stopped in 2/14 Immunosuppression was discontinued in patients required hospital admission Continued Withdrawn
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