Use of Anti-Cytokine Therapy in Kidney Transplant Recipients with COVID-19.

Marta Bodro,Fritz Diekmann,Sabina Herrera,Laura Linares,Asunción Moreno,Alex Soriano,Frederic Cofan,María Angeles Marcos,Jose Ríos

doi:10.3390/jcm10081551

Abstract

In the context of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to evaluate the impact of anti-cytokine therapies (AT) in kidney transplant recipients requiring hospitalization due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is an observational retrospective study, which included patients from March to May 2020. An inverse probability of treatment weighting from a propensity score to receive AT was used in all statistical analyses, and we applied a bootstrap procedure in order to calculate an estimation of the 2.5th and 97.5th percentiles of odds ratio (OR). outcomes were measured using an ordinal scale determination (OSD). A total of 33 kidney recipients required hospitalization and 54% of them received at least one AT, mainly tocilizumab (42%), followed by anakinra (12%). There was no statistical effect in terms of intensive care unit (ICU) admission, respiratory secondary infections (35% vs. 7%) or mortality (16% vs. 13%) comparing patients that received AT with those who did not. Nevertheless, patients who received AT presented better outcomes during hospitalization in terms of OSD ≥5 ((OR 0.31; 2.5th, 97.5th percentiles (0.10; 0.72)). These analyses indicate, as a plausible hypothesis, that the use of AT in kidney transplant recipients presenting with COVID-19 could be beneficial, even though multicenter randomized control trials using these therapies in transplanted patients are needed.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China, and this novel coronavirus caused a national outbreak of severe pneumonia (coronavirus disease 2019 (COVID-19)) in China, rapidly spreading around the world thereafter, with more than 100,000,000 confirmed cases [1].SARS-CoV-2 causes respiratory symptoms similar to those reported for SARS-CoV and Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
1742 patients were hospitalized due to COVID-19 in our hospital and 33 of them were kidney transplant recipients
We found that the mortality rate of kidney transplant-recipients was similar to that of

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China, and this novel coronavirus caused a national outbreak of severe pneumonia (coronavirus disease 2019 (COVID-19)) in China, rapidly spreading around the world thereafter, with more than 100,000,000 confirmed cases [1].SARS-CoV-2 causes respiratory symptoms similar to those reported for SARS-CoV and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China, and this novel coronavirus caused a national outbreak of severe pneumonia (coronavirus disease 2019 (COVID-19)) in China, rapidly spreading around the world thereafter, with more than 100,000,000 confirmed cases [1]. Confirmed after in the rest of the world, the most common symptoms of COVID-19 were fever and dry cough at the onset of illness [2,3,4]. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 have a cytokine storm syndrome, characterized by increased interleukin (IL)-1, IL-6, IL-7, interferon-γ inducible protein 10 among others [3,5].

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