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. 2020 Oct;22(5):e13377.
doi: 10.1111/tid.13377. Epub 2020 Jul 28.

SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region

Federica Maritati  1 , Elisabetta Cerutti  2 , Lina Zuccatosta  3 , Alessandro Fiorentini  4 , Carolina Finale  1 , Marta Ficosecco  5   6 , Fabrizio Cristiano  7 , Alessandro Capestro  8 , Emilio Balestra  1 , Domenica Taruscia  1 , Marco Vivarelli  9 , Abele Donati  5   6 , Gian Piero Perna  10 , Andrea Giacometti  4 , Marcello Tavio  11 , Maicol Onesta  12 , Laura Di Sante  13 , Andrea Ranghino  1
Affiliations

SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region

Federica Maritati et al. Transpl Infect Dis. 2020 Oct.

Abstract

Background: Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear.

Methods: In this report, we describe the clinical data, the treatments, and the outcomes of 5 KTRs with SARS-CoV-2 admitted to our hospital in Ancona, Marche region, Italy, from March 17 to present. Due to the severity of SARS-CoV-2, immunosuppression with calcineurin inhibitors, antimetabolites, and mTOR-inhibitors were stopped at the admission. All KTRs were treated with low-dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose.

Results: Overall, the incidence of SARS-CoV-2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present, two patients died, two patients were discharged, and one is still inpatient in ICU.

Conclusions: The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin-6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS-CoV-2-affected KTRs, a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase in the laboratory values such as D-dimer.

Keywords: Cytosorb; SARS-CoV-2; kidney transplant; tocilizumab.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Chest computed tomography (CT) images of a kidney transplant recipient affected by SARS‐CoV‐2 treated with tocilizumab. (A) Multiple bilateral ground‐glass opacities, prominent on the right. (B) Multiple patchy subpleural consolidations bilaterally. (C‐D) Chest CT scans of the same patient eight days after tocilizumab administration, showing an improvement of lung infiltrates
See this image and copyright information in PMC

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