Remdesivir in kidney transplant patients with SARS-CoV-2 pneumonia

Abstract

Background: Remdesivir is the only antiviral treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Its effects in Kidney transplant (KT) patients are limited to some published cases.

Methods: We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and December 31, 2020 with SARS-CoV-2 pneumonia who received remdesivir. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir.

Discussion: A total of 37 KT patients developed SARS-CoV-2 infection, 7 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. 4 were men, the median age was 59 (53-71) years. Median time from transplantation was 43 (16-82) months. Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 3 cases. Only 2 cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. 2 patients rise up 1.5 times the liver function test. No patient died or required admission to the critical care unit. Median days of admission was 12 (9-27) days.

Conclusions: Our study suggests that the use of remdesivir could be useful in KT patients with SARS-CoV-2 pneumonia without side effects. Additional studies are necessary with a larger number of patients to improve the knowledge of this drug in SARS-CoV-2 infection.

Keywords: Acute kidney failure; Fracaso renal agudo; Kidney transplantation; Remdesivir; SARS-CoV-2; Supervivencia; Survival; Trasplante renal; Tratamiento; Treatment.

Fig. 1

A. Evolution of creatinine in the laboratory tests of kidney transplant patients (n = 7) based on baseline creatinine and its evolution during admission (day 0, day +7 and day +14). The creatinine median and interquartile range show kidney function stability during admission. B. Evolution of lymphocytes in the laboratory tests of kidney transplant patients (n = 7) from admission (day 0, day +7 and day +14). The lymphocytes median and interquartile range show a progressive increase from admission, with the start of recovery without reaching normality on day 14. C. Evolution of the ALT enzyme in the laboratory tests of kidney transplant patients (n = 7) from admission (day 0, day +7 and day +14). The ALT median and interquartile range show a progressive increase during admission. The horizontal red lines show normal values. D. Evolution of CRP in the laboratory tests of kidney transplant patients (n = 7) from admission (day 0, day +7 and day +14). The CRP median and interquartile range show a decrease during the first seven days of admission.