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Han A, Min S, Jo EA, Lee H, Kim YC, Han SS, Kang HG, Ahn YH, Oh I, Song EY, Ha J. Association Between Low Anti-spike Antibody Levels After the Third Dose of SARS-CoV-2 Vaccination and Hospitalization due to Symptomatic Breakthrough Infection in Kidney Transplant Recipients. Ann Lab Med 2024; 44:64-73. [PMID: 37665287 PMCID: PMC10485855 DOI: 10.3343/alm.2024.44.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Whether anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels post-third coronavirus disease (COVID-19) vaccination correlate with worse outcomes due to breakthrough infection is unclear. We evaluated the association between anti-SARS-CoV-2 antibody levels and symptomatic breakthrough infection or hospitalization during the Omicron surge in kidney transplant recipients. Methods In total, 287 kidney transplant recipients expected to receive a third vaccination were enrolled between November 2021 and February 2022. The Abbott SARS-CoV-2 IgG II Quant test (Abbott, Chicago, IL, USA) was performed within three weeks before and four weeks after the third vaccination. The incidence of symptomatic breakthrough infection and hospitalization from two weeks to four months post-third vaccination was recorded. Results After the third vaccination, the seropositive rate and median antibody titer of the 287 patients increased from 57.1% to 82.2% and from 71.7 (interquartile range [IQR] 7.2-402.8) to 1,612.1 (IQR 153.9-5,489.1) AU/mL, respectively. Sixty-four (22.3%) patients had symptomatic breakthrough infections, of whom 12 required hospitalization. Lower anti-receptor-binding domain (RBD) IgG levels (<400 AU/mL) post-third vaccination were a risk factor for symptomatic breakthrough infection (hazard ratio [HR]=3.46, P<0.001). Anti-RBD IgG levels <200 AU/mL were a critical risk factor for hospitalization (HR=36.4, P=0.007). Conclusions Low anti-spike IgG levels after third vaccination in kidney transplant recipients were associated with symptomatic breakthrough infection and, particularly, with hospitalization during the Omicron surge. These data can be used to identify patients requiring additional protective measures, such as passive immunization using monoclonal antibodies.
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Affiliation(s)
- Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Ah Jo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Inseong Oh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Hanusz K, Domański P, Strojec K, Zapała P, Zapała Ł, Radziszewski P. Prostate Cancer in Transplant Receivers-A Narrative Review on Oncological Outcomes. Biomedicines 2023; 11:2941. [PMID: 38001942 PMCID: PMC10669184 DOI: 10.3390/biomedicines11112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Prostate cancer (PCa) is a low tumor mutational burden (TMB) cancer with a poor response to immunotherapy. Nonetheless, immunotherapy can be useful, especially in metastatic castration-resistant PCa (mCRPC). Increased cytotoxic T lymphocytes (CTLs) density is correlated with a shorter overall survival (OS), an early biochemical relapse, and a generally poor PCa prognosis. An increased number of CCR4+ regulatory T cells (CCR4 + Tregs) relates to a higher Gleason score or earlier progression. The same therapeutic options are available for renal transplant recipients (RTRs) as for the population, with a comparable functional and oncological outcome. Radical retropubic prostatectomy (RRP) is the most common method of radical treatment in RTRs. Brachytherapy and robot-assisted radical prostatectomy (RARP) seem to be promising therapies. Further studies are needed to assess the need for prostatectomy in low-risk patients before transplantation. The rate of adverse pathological features in RTRs does not seem to differ from those observed in the non-transplant population and the achieved cancer control seems comparable. The association between PCa and transplantation is not entirely clear. Some researchers indicate a possible association between a more frequent occurrence of PCa and a worse prognosis in advanced or metastatic PCa. However, others claim that the risk and survival prognosis is comparable to the non-transplant population.
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Affiliation(s)
- Karolina Hanusz
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Domański
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Kacper Strojec
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
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Tavares J, Oliveira JP, Reis P, Ribeiro B, Silva F, Malheiro J, Almeida M, Martins LS, Cabrita A, Henriques AC, Dias L. COVID-19 em receptores de transplante renal: o que aprendemos um ano depois? Um estudo de coorte a partir de um centro terciário. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0257pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Resumo Introdução: Os receptores de transplante renal (TR) apresentam um alto risco para desfechos adversos de infecções, tais como a COVID-19. Métodos: Revisamos retrospectivamente todos os receptores de TR com COVID-19 documentada entre 1º de Março de 2020 e 15 de Março de 2021, e analisamos as características, curso clínico, tratamento e desfechos dos pacientes. Resultados: Identificamos 123 pacientes, 72% do sexo masculino, com uma média de idade de 54,5±13,0 anos. Vinte por cento eram assintomáticos, 7% apresentaram transmissão nosocomial, e 36% do restante necessitaram de internação. Quase todos os pacientes internados receberam oxigênio, 30% necessitaram de ventilação mecânica invasiva (VMI), mais da metade apresentou lesão renal aguda, com 10% necessitando de diálise, e 20% foram a óbito. A incidência foi comparável à da população portuguesa, mas a taxa de mortalidade foi quase quatro vezes superior (TMP de 3,768 (IC 95%: 1,723-7,154). Maior índice de massa corporal (OR 1,275; P=0,001), menor função do enxerto basal (OR 0,968; P=0,015), e transmissão nosocomial (OR 13,836; P=0,019) foram associados à demanda de oxigênio, enquanto sexo feminino (OR 3,801; P=0,031) e menor função do enxerto renal basal (OR 0,955; P=0,005), mas não índice de massa corporal, foram associados à VMI e/ou óbito. Conclusão: A taxa de mortalidade em pacientes com TR foi mais elevada do que na população em geral e a função renal basal mais baixa foi o marcador mais consistente para desfechos adversos.
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Affiliation(s)
| | | | - Pedro Reis
- Centro Hospitalar Universitário do Porto, Portugal
| | | | - Filipa Silva
- Centro Hospitalar Universitário do Porto, Portugal
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Ogando NS, Metscher E, Moes DJAR, Arends EJ, Tas A, Cross J, Snijder EJ, Teng YKO, de Vries APJ, van Hemert MJ. The Cyclophilin-Dependent Calcineurin Inhibitor Voclosporin Inhibits SARS-CoV-2 Replication in Cell Culture. Transpl Int 2022; 35:10369. [PMID: 35812159 PMCID: PMC9263094 DOI: 10.3389/ti.2022.10369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
Kidney transplant recipients (KTRs) are at increased risk for a more severe course of COVID-19, due to their pre-existing comorbidity and immunosuppression. Consensus protocols recommend lowering immunosuppression in KTRs with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but the optimal combination remains unclear. Calcineurin inhibitors (CNIs) are cornerstone immunosuppressants used in KTRs and some have been reported to possess antiviral activity against RNA viruses, including coronaviruses. Here, we evaluated the effect of the CNIs tacrolimus, cyclosporin A, and voclosporin (VCS), as well as other immunosuppressants, on SARS-CoV-2 replication in cell-based assays. Unexpected, loss of compound due to plastic binding and interference of excipients in pharmaceutical formulations (false-positive results) complicated the determination of EC50 values of cyclophilin-dependent CNI’s in our antiviral assays. Some issues could be circumvented by using exclusively glass lab ware with pure compounds. In these experiments, VCS reduced viral progeny yields in human Calu-3 cells at low micromolar concentrations and did so more effectively than cyclosporin A, tacrolimus or other immunosuppressants. Although, we cannot recommend a particular immunosuppressive regimen in KTRs with COVID-19, our data suggest a potential benefit of cyclophilin-dependent CNIs, in particular VCS in reducing viral progeny, which warrants further clinical evaluation in SARS-CoV-2-infected KTRs.
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Affiliation(s)
- Natacha S. Ogando
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Erik Metscher
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Dirk Jan A. R. Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Eline J. Arends
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Ali Tas
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Eric J. Snijder
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Y. K. Onno Teng
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P. J. de Vries
- Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn J. van Hemert
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Martijn J. van Hemert,
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Amsei TQM, Gorayeb-Polacchini FS, Caldas HC, Fernandes-Charpiot IMM, Ferreira-Baptista MAS, Abbud-Filho M. Effect of the COVID-19 Pandemic on Kidney Transplant and on Chronic Dialysis Patients. Transplant Proc 2022; 54:1282-1285. [PMID: 35589414 PMCID: PMC8995325 DOI: 10.1016/j.transproceed.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The reported fatality rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients receiving maintenance dialysis or kidney transplant are higher than in the general population. The aim of this study was to evaluate the impact of SARS-CoV-2 infection in chronic dialysis patients (DPs) compared with kidney transplant recipients (KTxRs). METHODS A study evaluating 266 COVID-19-positive patients (112 DPs and 154 KTxRs) was conducted in a single center from March 1, 2020, to June 30, 2021. All patients were confirmed for COVID-19 infection by reverse transcription polymerase chain reaction or antigen test. RESULTS KTxRs were younger (49 ± 12.4 vs 61 ± 14.6 years; P < .0001) and had significantly fewer coexisting disorders than the DPs. A higher percentage of KTxRs required hospitalization (70% vs 49.4%, P = .002) and intensive care unit admission (39% vs 25%, P = .01). The fatality rate was 24% in both groups. DISCUSSION There is no consensus among studies about the higher fatality rate between KTxRs and DPs who develop COVID-19. In our study, we also did not find a different fatality rate. CONCLUSION In spite of KTxRs being younger and having fewer coexisting disorders, compared with DPs, they presented a higher hospitalization and intensive care unit necessity rate but a similar fatality rate.
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Affiliation(s)
- Thamiris Quiqueto Marinelli Amsei
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Fernanda Salomão Gorayeb-Polacchini
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Heloisa Cristina Caldas
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil
| | - Ida Maria Maximina Fernandes-Charpiot
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Maria Alice Sperto Ferreira-Baptista
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil
| | - Mario Abbud-Filho
- Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil,Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil,Address correspondence to Mario Abbud-Filho, MD, PhD, Departamento de Medicina/Nefrologia, Laboratório de Imunologia e Transplante Experimental - LITEX, Faculdade de Medicina de São José do Rio Preto - FAMERP, Brigadeiro Faria Lima Avenue, number 5416, 15090-000 São Jose do Rio Preto, SP, Brazil. Tel: (+55) 173201-5739
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6
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Kakos CD, Ziogas IA, Tsoulfas G. Pediatric transplantation during the COVID-19 pandemic. World J Transplant 2022; 12:88-99. [PMID: 35663540 PMCID: PMC9136715 DOI: 10.5500/wjt.v12.i5.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seem to have a better prognosis than adults. Nevertheless, pediatric solid organ transplantation (SOT) has been significantly affected by the unprecedented coronavirus disease 2019 (COVID-19) pandemic during the pre-, peri-, and post-transplant period. Undoubtedly, immunosuppression constitutes a real challenge for transplant clinicians as increased immunosuppression may prolong disease recovery, while its decrease can contribute to more severe symptoms. To date, most pediatric SOT recipients infected by SARS-CoV-2 experience mild disease with only scarce reports of life-threatening complications. As a consequence, after an initial drop during the early phase of the pandemic, pediatric SOTs are now performed with the same frequency as during the pre-pandemic period. This review summarizes the currently available evidence regarding pediatric SOT during the COVID-19 pandemic.
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Affiliation(s)
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Aristotle University School of Medicine, Thessaloniki 54622, Greece
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7
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AKAGUN TULIN, TOMAR OZDEMKAVRAZ, USTA MURAT, BAYLAN SULEYMAN. COVID-19 INFECTION IN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE. Transplant Proc 2022; 54:1424-1428. [PMID: 35649965 PMCID: PMC8995207 DOI: 10.1016/j.transproceed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/25/2022]
Abstract
Background Methods Results Conclusions
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8
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Cremoni M, Cuozzo S, Martinuzzi E, Barbosa S, Ben Hassen N, Massa F, Demonchy E, Durand M, Thaunat O, Esnault V, Le Quintrec M, Caillard S, Glaichenhaus N, Sicard A. Low T Cell Responsiveness in the Early Phase of COVID-19 Associates with Progression to Severe Pneumonia in Kidney Transplant Recipients. Viruses 2022; 14:v14030542. [PMID: 35336949 PMCID: PMC8949290 DOI: 10.3390/v14030542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022] Open
Abstract
Kidney transplant (KT) recipients are at increased risk of developing severe forms of COVID-19. Little is known about the immunological mechanisms underlying disease severity in these patients receiving T-cell targeting immunosuppressive drugs. We investigated the relationship between T cell responsiveness at the beginning of the infection and the risk of subsequent progression to respiratory failure. We performed a multicentric prospective study in KT recipients with a positive RT-PCR COVID-19 test and only mild symptoms at inclusion. Blood samples were collected at baseline in a cell culture system containing T cell stimuli. We assessed T cell responsiveness by computing the ratio between the levels of Th1, Th2, Th17 and Treg cytokines produced after polyclonal stimulation and the number of blood lymphocytes. We then used an unsupervised classification approach to stratify patients into low and high T cell responders and a penalized logistic regression to evaluate the association between T cell responsiveness and progression to severe pneumonia. Forty-five patients were included. All patients who progressed to severe pneumonia (24.4%, n = 11) were low T cell responders at baseline (p = 0.01). In multivariate analysis, low T cell responsiveness at baseline was the main risk factor for subsequent progression to severe pneumonia. This study provides novel insights into the mechanisms underlying COVID-19 severity in organ transplant recipients and data of interest to clinicians managing immunosuppressive drugs in these patients.
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Affiliation(s)
- Marion Cremoni
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France; (M.C.); (S.C.); (N.B.H.); (V.E.)
- Clinical Research Unit Côte d’Azur (UR2CA), University Côte d’Azur, 06200 Nice, France
| | - Sébastien Cuozzo
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France; (M.C.); (S.C.); (N.B.H.); (V.E.)
| | - Emanuela Martinuzzi
- Institute of Molecular and Cellular Pharmacology, University Côte d’Azur, CNRS, 06560 Valbonne, France; (E.M.); (S.B.); (N.G.)
| | - Susana Barbosa
- Clinical Research Unit Côte d’Azur (UR2CA), University Côte d’Azur, 06200 Nice, France
- Institute of Molecular and Cellular Pharmacology, University Côte d’Azur, CNRS, 06560 Valbonne, France; (E.M.); (S.B.); (N.G.)
| | - Nadia Ben Hassen
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France; (M.C.); (S.C.); (N.B.H.); (V.E.)
- Clinical Research Unit Côte d’Azur (UR2CA), University Côte d’Azur, 06200 Nice, France
| | - Filippo Massa
- Laboratory of Molecular Physio Medicine, University Côte d’Azur, CNRS, 06107 Nice, France;
| | - Elisa Demonchy
- Infectious Diseases Department, Archet 1 Hospital, Nice University Hospital, 06200 Nice, France;
| | - Matthieu Durand
- Urology Department, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France;
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, 69003 Lyon, France;
| | - Vincent Esnault
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France; (M.C.); (S.C.); (N.B.H.); (V.E.)
| | - Moglie Le Quintrec
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Lapeyronie, 34090 Montpellier, France;
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67091 Strasbourg, France;
| | - Nicolas Glaichenhaus
- Clinical Research Unit Côte d’Azur (UR2CA), University Côte d’Azur, 06200 Nice, France
- Institute of Molecular and Cellular Pharmacology, University Côte d’Azur, CNRS, 06560 Valbonne, France; (E.M.); (S.B.); (N.G.)
| | - Antoine Sicard
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, 06001 Nice, France; (M.C.); (S.C.); (N.B.H.); (V.E.)
- Laboratory of Molecular Physio Medicine, University Côte d’Azur, CNRS, 06107 Nice, France;
- Correspondence: ; Tel.: +33-(0)4-9203-7918
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Tavares J, Oliveira JP, Reis P, Ribeiro B, Silva F, Malheiro J, Almeida M, Martins LS, Cabrita A, Henriques AC, Dias L. COVID-19 in kidney transplant recipients: what have we learned one year later? A cohort study from a tertiary center. J Bras Nefrol 2022; 44:533-542. [PMID: 35788618 PMCID: PMC9838675 DOI: 10.1590/2175-8239-jbn-2021-0257en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/10/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. METHODS We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients' characteristics, clinical course, treatment, and outcomes. RESULTS We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. CONCLUSION Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes.
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Affiliation(s)
- Joana Tavares
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - João Pedro Oliveira
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - Pedro Reis
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - Bárbara Ribeiro
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - Filipa Silva
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - Jorge Malheiro
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - Manuela Almeida
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - La Salete Martins
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | - António Cabrita
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
| | | | - Leonídio Dias
- Centro Hospitalar Universitário do Porto, Departamento de Nefrologia, Porto, Portugal
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10
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Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121327. [PMID: 34946272 PMCID: PMC8703670 DOI: 10.3390/medicina57121327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman's correlation coefficient -0.4, p = 0.02), percentage of CD19+ cells (r = -0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.
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11
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Daoud A, Alqassieh A, Alkhader D, Posadas Salas MA, Rao V, Fülöp T, Soliman KM. Immunosuppression in kidney transplant recipients with COVID-19 infection - where do we stand and where are we heading? Ren Fail 2021; 43:273-280. [PMID: 33491531 PMCID: PMC7850379 DOI: 10.1080/0886022x.2021.1876730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/02/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
The appropriate immunosuppressive regimen in kidney transplant recipients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19) infection remains unclear. The impact of direct virus injury complicated by dysregulated hyperimmune response with overwhelming release of various cytokines in COVID-19 infected subjects contributes to the complexity of management. The largest concern of the practicing clinicians at current time is how to tailor maintenance immune-modulating therapy during active viral infection and the efficacy of the soon-to-be upcoming immunization for COVID-19. This targeted review aims to cover most of the current evidence on the effect of key maintenance immunosuppressive agents in COVID-19 infection and proposes a line of management to specific scenarios on this very rapidly evolving subject.
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Affiliation(s)
- Ahmed Daoud
- Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Duaa Alkhader
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Aurora Posadas Salas
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Vinaya Rao
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Karim M. Soliman
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
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12
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Jonny, Violetta L, Kartasasmita AS, Amirullah Roesli RM, Rita C. Pharmacological Treatment Options for Coronavirus Disease-19 in Renal Patients. Int J Nephrol 2021; 2021:4078713. [PMID: 34858665 PMCID: PMC8632427 DOI: 10.1155/2021/4078713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with chronic kidney disease (CKD), including dialysis and transplant patients, are at greater risk of contracting SARS-CoV-2 due to kidney dysfunction and preexisting comorbidities. To date, a specific guideline on managing these high-risk patients infected with COVID-19 has not been established. As the current management of COVID-19 comprises mainly experimental drugs, the authors aim to provide information on dosing adjustments at different stages of kidney dysfunction and notable renal side effects. We performed a nonsystematical review of currently available COVID-19 drugs exploring several different clinical trial databases and search browsers. Several antivirals and monoclonal antibodies used in COVID-19 treatment require dosage adjustments in kidney dysfunction. In a global pandemic setting, nephrologists need to consider the appropriate dosage according to the renal function and closely monitor the side effects of different drug combinations to obtain the optimum therapeutic effect while avoiding further renal damage. Further studies are required to determine the safety and efficacy of these drugs in renal patients.
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Affiliation(s)
- Jonny
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | - Laurencia Violetta
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | | | | | - Coriejati Rita
- Faculty of Medicine, Universitas Padjajaran, Bandung, West Java, Indonesia
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13
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Rahbar M, Rahimzadeh H, Aghsaeifard Z, Bagherpour F, Namdari F, Latifi M, Dialameh H, Taheri Mahmoudi M, Niroumand Jalai M, Dehghani S. COVID-19 Infection in Kidney Transplant Recipients From a Single Center in Iran. EXP CLIN TRANSPLANT 2021; 20:130-135. [PMID: 34775943 DOI: 10.6002/ect.2021.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES COVID-19 has been spreading rapidly throughout the world, with nearly every country thus far documenting this infection. In this study, our aim was to evaluate the risk factors for increased mortality in deceased donor kidney transplant recipients with COVID-19 at a single center in Iran. MATERIALS AND METHODS This was a retrospective study in a single center. During the 17-month ongoing COVID19 pandemic in Iran, there were 153 deceased donor kidney recipients at our center with suspected COVID19 symptoms. Of these patients, 138 had positive COVID-19 tests, and thus a therapeutic regimen was commenced for these patients. Data were analyzed with SPSS version 16 software. RESULTS The patients were predominantly male (83, 60.1%) with a median age of 47.09 ± 13.75 years and a median time since transplant of 51 months (IQR, 1-276 months). Among these patients, 84 (60.8%) had hypertension and 43 (31.2%) had diabetes mellitus. We observed a significant relationship between disease severity and mortality (P < .001). After risk adjustments for age, presence of diabetes mellitus and hypertension and blood group type were factors that showed a significantly higher risk of death. CONCLUSIONS Deceased donor kidney transplant recipients with confirmed COVID-19 experienced less fever as an initial symptom. However, recipients with COVID-19 and an underlying disease had a higher rate of mortality, severity of infection, and progression of disease. Appropriate management of renal complications and vaccinations in deceased donor kidney transplant recipients may help lead to more favorable outcomes.
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Affiliation(s)
- Maryam Rahbar
- From the Department of Nephrology, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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14
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Tseng HT, Wu XC, Huang CY, Shih CM, Lin YW, Lin FY. The Impact of SARS-CoV-2 Infection, and Application of Immunosuppressive Agents in Kidney Transplant Recipients Suffering from COVID-19. Pharmaceuticals (Basel) 2021; 14:ph14101054. [PMID: 34681278 PMCID: PMC8537512 DOI: 10.3390/ph14101054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
In December 2019, the COVID-19 pandemic began to ravage the world quickly, causing unprecedented losses in human life and the economy. A statistical study revealed that the proportion of solid organ transplant (SOT) recipients with severe symptoms and deaths after being infected by SARS-CoV-2 is considerably higher than that of non-SOT recipients, and the prognosis is relatively poor. In addition, the clinical manifestation of SOT recipients suffering from COVID-19 is different from that of general COVID-19 patients. Acute kidney injury (AKI) is a common complication in COVID-19 patients, and it is likely more common among SOT recipients infected with SARS-CoV-2. Clinical experts consider that SOT recipients have long-term treatment with immunosuppressants, and the comorbidities are driven by a high rate of severe symptoms and mortality. Orthotopic kidney allograft transplantation is an effective treatment for patients suffering from end-stage kidney disease/kidney failure through which they can easily extend their life. Indeed, kidney transplant recipients have suffered significant damage during this pandemic. To effectively reduce the severity of symptoms and mortality of kidney transplant recipients suffering from COVID-19, precise application of various drugs, particularly immunosuppressants, is necessary. Therefore, herein, we will collate the current clinical experience of treating COVID-19 infection in kidney transplant recipients and discuss the adjustment of patients using immunosuppressive agents in the face of COVID-19.
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Affiliation(s)
- Horng-Ta Tseng
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Xiang-Chi Wu
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Yao Huang
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Ming Shih
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yi-Wen Lin
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Institute of Oral Biology, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: (Y.-W.L.); (F.-Y.L.); Tel.: +886-2-87910329 (Y.-S.J.)
| | - Feng-Yen Lin
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan; (H.-T.T.); (X.-C.W.); (C.-Y.H.); (C.-M.S.)
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Departments of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (Y.-W.L.); (F.-Y.L.); Tel.: +886-2-87910329 (Y.-S.J.)
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15
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Moussa M, Chakra MA, Papatsoris AG, Dellis A. The Impact of COVID-19 Disease on Urology Practice. Surg J (N Y) 2021; 7:e83-e91. [PMID: 34104720 PMCID: PMC8175122 DOI: 10.1055/s-0041-1725155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
The diagnosis and timely treatment of cancer patients should not be compromised during an infectious disease pandemic. The pandemic of coronavirus disease 2019 (COVID-19) has serious implications on urology practice and raises particular questions for urologists about the management of different conditions. It was recommended to cancel most of the elective urological surgeries. Urological cancers surgeries that should be prioritized are radical cystectomy for selective tumors, orchiectomy for suspected testicular tumors, nephrectomy for c T3 + , nephroureterectomy for high-grade disease, and radical adrenalectomy for tumors >6 cm or adrenal carcinoma. Most prostatectomies can be delayed without compromising the survival rate of patients. Urological emergencies should be treated adequately even during this pandemic. There is a potential risk of coronavirus diffusion during minimally invasive procedures performed. It is crucial to use specific precautions when urologists performed those type of surgeries. It was also recommended to suspend the kidney transplantation program during the COVID-19 pandemic except for specific cases. In this review, we discussed the triage of urological surgeries, the risk of minimally invasive urological procedure, the kidney transplantation challenges, the systemic therapies, intravesical instillation of Bacillus Calmette-Guérin (BCG), endourology, teleconferencing, and telemedicine application in urology during the COVID-19 pandemic.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital & Lebanese University, Beirut, Lebanon
| | | | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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16
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Khairallah P, Aggarwal N, Awan AA, Vangala C, Airy M, Pan JS, Murthy BVR, Winkelmayer WC, Ramanathan V. The impact of COVID-19 on kidney transplantation and the kidney transplant recipient - One year into the pandemic. Transpl Int 2021; 34:612-621. [PMID: 33545741 PMCID: PMC8013003 DOI: 10.1111/tri.13840] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
The COVID‐19 pandemic has significantly changed the landscape of kidney transplantation in the United States and worldwide. In addition to adversely impacting allograft and patient survival in postkidney transplant recipients, the current pandemic has affected all aspects of transplant care, including transplant referrals and listing, organ donation rates, organ procurement and shipping, and waitlist mortality. Critical decisions were made during this period by transplant centers and individual transplant physicians taking into consideration patient safety and resource utilization. As countries have begun administering the COVID vaccines, new and important considerations pertinent to our transplant population have arisen. This comprehensive review focuses on the impact of COVID‐19 on kidney transplantation rates, mortality, policy decisions, and the clinical management of transplanted patients infected with COVID‐19.
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Affiliation(s)
- Pascale Khairallah
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| | - Nidhi Aggarwal
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.,Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ahmed A Awan
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| | - Chandan Vangala
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.,Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Medha Airy
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| | - Jenny S Pan
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.,Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Bhamidipati V R Murthy
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| | - Wolfgang C Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| | - Venkat Ramanathan
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA.,Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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17
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Bitencourt L, Pedrosa AL, de Brito SBCS, Fróes ACF, de Carvalho ST, Fonseca GG, Ferreira GC, Fradico PF, Simões E Silva AC. COVID-19 and Renal Diseases: An Update. Curr Drug Targets 2021; 22:52-67. [PMID: 33050860 DOI: 10.2174/1389450121999201013151300] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease. METHODS Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications. CONCLUSION The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.
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Affiliation(s)
- Letícia Bitencourt
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Luisa Pedrosa
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Stephanie Bruna Camilo Soares de Brito
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cláudia Fontoura Fróes
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Sarah Tayná de Carvalho
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Giulio Gori Fonseca
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Guilherme Costa Ferreira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Pollyanna Faria Fradico
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
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18
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Candon S, Guerrot D, Drouot L, Lemoine M, Lebourg L, Hanoy M, Boyer O, Bertrand D. T cell and antibody responses to SARS-CoV-2: Experience from a French transplantation and hemodialysis center during the COVID-19 pandemic. Am J Transplant 2021; 21:854-863. [PMID: 33047493 PMCID: PMC7675512 DOI: 10.1111/ajt.16348] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
Immunosuppressed organ-transplanted patients are considered at risk for severe forms of COVID-19. Moreover, exaggerated innate and adaptive immune responses might be involved in severe progression of the disease. However, no data on the immune response to SARS-CoV-2 in transplanted patients are currently available. Here, we report the first assessment of antibody and T cell responses to SARS-CoV-2 in 11 kidney-transplanted patients recovered from RT-PCR-confirmed (n = 5) or initially suspected (n = 6) COVID-19. After reduction of immunosuppressive therapy, RT-PCR-confirmed COVID-19 transplant patients were able to mount vigorous antiviral T cell and antibody responses, as efficiently as two nontherapeutically immunosuppressed COVID-19 patients on hemodialysis. By contrast, six RT-PCR-negative patients displayed no antibody response. Among them, three showed very low numbers of SARS-CoV-2-reactive T cells, whereas no T cell response was detected in the other three, potentially ruling out COVID-19 diagnosis. Low levels of T cell reactivity to SARS-CoV-2 were also detected in seronegative healthy controls without known exposure to the virus. These results suggest that during COVID-19, monitoring both T cell and serological immunity might be helpful for the differential diagnosis of COVID-19 but are also needed to evaluate a potential role of antiviral T cells in the development of severe forms of the disease.
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Affiliation(s)
- Sophie Candon
- Department of Immunology and BiotherapiesRouen University HospitalRouenFrance,INSERM U1234University of Rouen NormandyRouenFrance
| | - Dominique Guerrot
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | | | - Mathilde Lemoine
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Ludivine Lebourg
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Mélanie Hanoy
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Olivier Boyer
- Department of Immunology and BiotherapiesRouen University HospitalRouenFrance,INSERM U1234University of Rouen NormandyRouenFrance
| | - Dominique Bertrand
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
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19
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Bae S, McAdams-DeMarco MA, Massie AB, Ahn JB, Werbel WA, Brennan DC, Lentine KL, Durand CM, Segev DL. Early Changes in Kidney Transplant Immunosuppression Regimens During the COVID-19 Pandemic. Transplantation 2021; 105:170-176. [PMID: 33093404 PMCID: PMC7752821 DOI: 10.1097/tp.0000000000003502] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Kidney transplant recipients have higher risk of infectious diseases due to their reliance on immunosuppression. During the current COVID-19 pandemic, some clinicians might have opted for less potent immunosuppressive agents to counterbalance the novel infectious risk. We conducted a nationwide study to characterize immunosuppression use and subsequent clinical outcomes during the first 5 months of COVID-19 pandemic in the United States. METHODS Using data from the Scientific Registry of Transplant Recipients, we studied all kidney-only recipients in the United States from January 1, 2017, to March 12, 2020 ("prepandemic" era; n = 64 849) and from March 13, 2020, to July 31, 2020 ("pandemic" era; n = 5035). We compared the use of lymphocyte-depleting agents (versus basiliximab or no induction) and maintenance steroids (versus steroid avoidance/withdrawal) in the pandemic era compared with the prepandemic era. Then, we compared early posttransplant outcomes by immunosuppression regimen during the pandemic era. RESULTS Recipients in the pandemic era were substantially less likely to receive lymphocyte-depleting induction agents compared with their prepandemic counterparts (aOR = 0.400.530.69); similar trends were found across subgroups of state-level COVID-19 incidence, donor type, and recipient age. However, lymphocyte-depleting induction agents were associated with decreased rejection during admission (aOR = 0.110.230.47) but not with increased mortality in the pandemic era (aHR = 0.130.471.66). On the other hand, the use of maintenance steroids versus early steroid withdrawal remained similar (aOR = 0.711.071.62). CONCLUSIONS The use of lymphocyte-depleting induction agents has decreased in favor of basiliximab and no induction during the COVID-19 pandemic. However, this shift might have resulted in increases in rejection with no clear reductions in posttransplant mortality.
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Affiliation(s)
- Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - JiYoon B Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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20
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Sagnelli C, Sica A, Gallo M, Peluso G, Varlese F, D’Alessandro V, Ciccozzi M, Crocetto F, Garofalo C, Fiorelli A, Iannuzzo G, Reginelli A, Schonauer F, Santangelo M, Sagnelli E, Creta M, Calogero A. Renal involvement in COVID-19: focus on kidney transplant sector. Infection 2021; 49:1265-1275. [PMID: 34611792 PMCID: PMC8491762 DOI: 10.1007/s15010-021-01706-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. MATERIALS AND METHODS The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. CONCLUSION This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie n. 1, 80138 Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Monica Gallo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131 Naples, Italy
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131 Naples, Italy
| | - Vincenzo D’Alessandro
- UOSD Centro Trapianti di rene e Chirurgia del Retroperitoneo, AOU-University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 80128 Rome, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania “Luigi Vanvitelli”, 80137 Naples, Italy
| | - Alfonso Fiorelli
- Department of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, 80137 Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University Naples, Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Fabrizo Schonauer
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131 Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie n. 1, 80138 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, via Pansini, 5, 80131 Naples, Italy
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21
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Nørgård BM, Nielsen J, Knudsen T, Nielsen RG, Larsen MD, Jølving LR, Kjeldsen J. Hospitalization for COVID-19 in patients treated with selected immunosuppressant and immunomodulating agents, compared to the general population: A Danish cohort study. Br J Clin Pharmacol 2020; 87:2111-2120. [PMID: 33098713 DOI: 10.1111/bcp.14622] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS In the Danish population, we examined whether patients treated with thiopurines, methotrexate, systemic corticosteroids, anti-tumour necrosis factor (TNF)-α agents, anti-interleukin therapeutic agents, selective immunosuppressive agents and cyclosporine/tacrolimus had an increased risk of hospitalization for COVID- 19, compared to the background population. METHODS A nationwide cohort study including all people alive in Denmark on 1 March 2020. Exposed patients constituted those exposed to thiopurines (n = 5484), methotrexate (n = 17 977), systemic corticosteroids (n = 55 868), anti-TNF-α agents (n = 17 857), anti-interleukin therapeutic agents (n = 3744), selective immunosuppressive agents (n = 3026) and cyclosporine/tacrolimus (n = 1143) in a period of 12 months prior to 1 March 2020 (estimated time of outbreak in Denmark). We estimated the adjusted risk of hospitalization for COVID-19 for patients treated with the above-mentioned categories of medications, compared to the rest of the population. RESULTS The adjusted odds ratios of hospitalization in patients treated with corticosteroids and cyclosporine/tacrolimus were 1.64 (95% confidence interval [CI] 1.35 to 2.00) and 4.75 (95% CI 1.96 to 11.49), respectively. The risks of hospitalization in patients treated with thiopurines, methotrexate, and anti-TNF-α agents, were 1.93 (95% CI 0.91 to 4.08), 0.74 (95% CI 0.43 to 1.28), 1.00 (95% CI 0.52 to 1.94), respectively. The number of outcomes in patients treated with anti-interleukin therapeutic agents and selective immunosuppressive agents was too small for analysis. CONCLUSION Patients treated with systemic corticosteroids and cyclosporine/tacrolimus had a significantly increased risk of being hospitalized for COVID-19. Our study does not uncover whether the increased risk is related to the drug itself, the underlying condition for which the patient is treated or other factors.
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Affiliation(s)
- Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torben Knudsen
- Department of Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark.,Department of Regional Health Science, Center Southwest Jutland, University of Southern Denmark, Esbjerg, Denmark
| | - Rasmus Gaardskaer Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Research Unit of Pediatrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Due Larsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark.,Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Jager KJ, Kramer A, Chesnaye NC, Couchoud C, Sánchez-Álvarez JE, Garneata L, Collart F, Hemmelder MH, Ambühl P, Kerschbaum J, Legeai C, Del Pino Y Pino MD, Mircescu G, Mazzoleni L, Hoekstra T, Winzeler R, Mayer G, Stel VS, Wanner C, Zoccali C, Massy ZA. Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney Int 2020; 98:1540-1548. [PMID: 32979369 PMCID: PMC7560263 DOI: 10.1016/j.kint.2020.09.006] [Citation(s) in RCA: 325] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk with the use of ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe from February 1, 2020, to April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19-attributable mortality was calculated using propensity score-matched historic control data and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants ≥75 years of age, 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy, a highly vulnerable population due to underlying chronic kidney disease and a high prevalence of multimorbidity.
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Affiliation(s)
- Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | | | - Liliana Garneata
- Romanian Renal Registry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine and Nephrology, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | | | - Marc H Hemmelder
- Dutch Renal Registry, Nefrovisie foundation, Utrecht, The Netherlands
| | - Patrice Ambühl
- Institute of Nephrology, Waid and Triemli City Hospital, Zurich, Switzerland
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Camille Legeai
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | | | - Gabriel Mircescu
- Romanian Renal Registry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine and Nephrology, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | | | - Tiny Hoekstra
- Dutch Renal Registry, Nefrovisie foundation, Utrecht, The Netherlands
| | - Rebecca Winzeler
- Institute of Nephrology, Waid and Triemli City Hospital, Zurich, Switzerland
| | - Gert Mayer
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP (Assistance Publique-Hôpitaux de Paris), Boulogne-Billancourt/Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 Team 5, Research Centre in Epidemiology and Population Health (CESP), University of Paris West-Versailles-St Quentin-en-Yveline (UVSQ), Villejuif, France
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23
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Akdur A, Karakaya E, Ayvazoglu Soy EH, Yarbug Karakayali F, Yildirim S, Torgay A, Sayin CB, Coskun M, Moray G, Haberal M. Liver and Kidney Transplant During a 6-Month Period in the COVID-19 Pandemic: A Single-Center Experience. EXP CLIN TRANSPLANT 2020; 18:564-571. [PMID: 33143601 DOI: 10.6002/ect.2020.0388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES With the declaration of COVID-19 as a pandemic, many studies have indicated that elective surgeries should be postponed. However, postponement of transplants may cause diseases to get worse and increase the number in wait lists. We believe that, with precautions, transplant does not pose a risk during pandemic. Here, we aimed to evaluate our transplant results, which we safely performed during a 6-month pandemic period. MATERIALS AND METHODS Until September 2020, 3140 kidney and 667 liver transplants have been performed in our centers. We evaluated 38 kidney transplants and 9 liver transplants procedures performed during the pandemic (March 1 to September 2, 2020). Recipient and donor candidates were screened for COVID-19 with polymerase chain reaction and thoracic computed tomography. All recipients had routine immunosuppressive protocol. During hospitalization at our COVID-19-free transplant facility, we restricted the interactions during multidisciplinary rounds. RESULTS During the pandemic, 38 kidney transplants with an average length of hospital stay of 8.1 days were performed. Mean serum creatinine values of recipients were 0.91, 0.86, and 0.74 mg/dL on postoperative days 7, 30, and 90, respectively. During the pandemic, 9 living donor liver transplants (1 adult, 8 pediatric) were performed with an average length of hospital stay of 17.1 days. Mean serum total bilirubin levels were 0.9, 0.5, and 0.4 mg/dL on postoperative days 7, 30, and 90, respectively. Mean serum aspartate aminotransferase levels were 38.1, 28.3, and 22.3 U/L on postoperative days 7, 30, and 90, respectively. All recipients and donors were successfully discharged. Only 1 liver recipient died (on day 55 after discharge as a result of oxalosis-induced heart failure). CONCLUSIONS According to our results, when precautions are taken, transplant does not pose a risk to patients during the pandemic period. We attribute the safety and success shown to our newly developed protocol in response to the COVID-19 pandemic.
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Affiliation(s)
- Aydincan Akdur
- From the Department of General Surgery, Baskent University Faculty of Medicine, Division of Transplantation, Ankara, Turkey
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24
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Rodriguez-Cubillo B, de la Higuera MAM, Lucena R, Franci EV, Hurtado M, Romero NC, Moreno AR, Valencia D, Velo M, Fornie IS, Sanchez-Fructuoso AI. Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2? Am J Transplant 2020; 20:3173-3181. [PMID: 32529737 PMCID: PMC7307110 DOI: 10.1111/ajt.16141] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 01/25/2023]
Abstract
Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID-19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID-19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine-based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID-19.
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Affiliation(s)
- Beatriz Rodriguez-Cubillo
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
- Correspondence Beatriz Rodriguez-Cubillo
| | | | - Rafael Lucena
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Elena V. Franci
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Maria Hurtado
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Daniela Valencia
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Mercedes Velo
- Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Iñigo S. Fornie
- Internal Medicine Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Ana I. Sanchez-Fructuoso
- Nephrology Department, Hospital Clinico San Carlos, University of Medicine Complutense de Madrid, Madrid, Spain
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25
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Marcault C, Fodil S, Dupont T, Darmon M, Azoulay E. Solid organ transplant recipients during COVID-19 pandemic. Am J Transplant 2020; 20:2960-2961. [PMID: 32515045 PMCID: PMC7300947 DOI: 10.1111/ajt.16126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/25/2023]
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26
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Bajpai D, Shah S. COVID-19 Pandemic and Pregnancy in Kidney Disease. Adv Chronic Kidney Dis 2020; 27:397-403. [PMID: 33308505 PMCID: PMC7413201 DOI: 10.1053/j.ackd.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a rapidly spreading pandemic. Owing to changes in the immune system and respiratory physiology, pregnant women are vulnerable to severe viral pneumonia. We review the clinical course, pregnancy outcomes, and management of women with COVID-19 in pregnancy with a focus on those with kidney involvement. Current evidence does not show an increased risk of acquiring SARS-CoV-2 during pregnancy and the maternal course appears to be similar to nonpregnant patients. However, severe maternal disease can lead to complex management challenges and has shown to be associated with higher incidence of preterm and caesarean births. The risk of congenital infection with SARS-CoV-2 is not known. All neonates must be considered as high-risk contacts and should be screened at birth and isolated. Pregnant women should follow all measures to prevent SARS-CoV-2 exposure and this fear should not compromise antenatal care. Use of telemedicine, videoconferencing, and noninvasive fetal and maternal home monitoring devices should be encouraged. High-risk pregnant patients with comorbidities and COVID-19 require hospitalization and close monitoring. Pregnant women with COVID-19 and kidney disease are a high-risk group and should be managed by a multidisciplinary team approach including a nephrologist and neonatologist.
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Affiliation(s)
- Divya Bajpai
- Department of Nephrology, Seth G.S.M.C & K.E.M. Hospital, Mumbai, India
| | - Silvi Shah
- Kidney C.A.R.E. Program, Division of Nephrology, University of Cincinnati, Cincinnati, OH.
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27
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Elias M, Pievani D, Randoux C, Louis K, Denis B, Delion A, Le Goff O, Antoine C, Greze C, Pillebout E, Abboud I, Glotz D, Daugas E, Lefaucheur C. COVID-19 Infection in Kidney Transplant Recipients: Disease Incidence and Clinical Outcomes. J Am Soc Nephrol 2020; 31:2413-2423. [PMID: 32847984 DOI: 10.1681/asn.2020050639] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. METHODS We enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform. RESULTS Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19-positive patients. CONCLUSIONS Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.
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Affiliation(s)
- Michelle Elias
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniele Pievani
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Randoux
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kevin Louis
- Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
| | - Blandine Denis
- Infectious Diseases Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Delion
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Océane Le Goff
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Corinne Antoine
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clarisse Greze
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Evangeline Pillebout
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Imad Abboud
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Glotz
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
| | - Eric Daugas
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Lefaucheur
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
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28
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Clinical Profiles in Renal Patients with COVID-19. J Clin Med 2020; 9:jcm9082665. [PMID: 32824683 PMCID: PMC7464139 DOI: 10.3390/jcm9082665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/08/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.
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29
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Wong SY, Brubaker AL, Wang AX, Taiwo AA, Melcher ML. What solid organ transplant healthcare providers should know about renin-angiotensin-aldosterone system inhibitors and COVID-19. Clin Transplant 2020; 34:e13991. [PMID: 32446267 PMCID: PMC7267091 DOI: 10.1111/ctr.13991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
The data on the outcomes of solid organ transplant recipients who have contracted coronavirus disease 2019 (COVID‐19) are still emerging. Kidney transplant recipients are commonly prescribed renin‐angiotensin‐aldosterone system (AAS) inhibitors given the prevalence of hypertension, diabetes, and cardiovascular disease. As the angiotensin‐converting enzyme 2 (ACE2) facilitates the entry of coronaviruses into target cells, there have been hypotheses that preexisting use of renin‐angiotensin‐aldosterone system (RAAS) inhibitors may increase the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Given the common use of RAAS inhibitors among solid organ transplant recipients, we sought to review the RAAS cascade, the mechanism of SARS‐CoV‐2 entry, and pertinent data related to the effect of RAAS inhibitors on ACE2 to guide management of solid organ transplant recipients during the COVID‐19 pandemic. At present, there is no clear evidence to support the discontinuation of RAAS inhibitors in solid organ transplant recipients during the COVID‐19 pandemic.
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Affiliation(s)
- Sunnie Y Wong
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
| | - Aleah L Brubaker
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
| | - Aileen X Wang
- Division of Nephrology, Dept. of Medicine, Stanford University, Stanford, CA, USA
| | - Adetokunbo A Taiwo
- Division of Nephrology, Dept. of Medicine, Stanford University, Stanford, CA, USA
| | - Marc L Melcher
- Division of Abdominal Transplantation, Dept. of Surgery, Stanford University, Stanford, CA, USA
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30
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Kemmner S, Guba MO, Schönermarck U, Stangl M, Fischereder M. Cyclosporine as a preferred calcineurin inhibitor in renal allograft recipients with COVID-19 infection. Kidney Int 2020; 98:507-508. [PMID: 32505466 PMCID: PMC7270808 DOI: 10.1016/j.kint.2020.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 10/30/2022]
Affiliation(s)
- Stephan Kemmner
- Transplant Center, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany.
| | - Markus O Guba
- Department of General, Visceral, and Transplant Surgery, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Ulf Schönermarck
- Renal Division, Department of Internal Medicine IV, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Manfred Stangl
- Department of General, Visceral, and Transplant Surgery, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Michael Fischereder
- Renal Division, Department of Internal Medicine IV, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany
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31
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Zaza G, Benedetti C, Fribourg M, Maggiore U, Azzi J, Riella LV, Cravedi P. SARS-CoV-2 pandemic and the need for transplant-oriented trials. Transpl Int 2020; 33:966-968. [PMID: 32333712 PMCID: PMC7267390 DOI: 10.1111/tri.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Claudia Benedetti
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Miguel Fribourg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Translational Transplant Research Center, New York, NY, USA
| | - Umberto Maggiore
- UO Nefrologia, Dipartimento di Medicina e Chirurgia, Azienda Ospedaliera-Universitaria Parma, Università di Parma, Parma, Italy
| | - Jamil Azzi
- Renal Division, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Leonardo V Riella
- Renal Division, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Translational Transplant Research Center, New York, NY, USA
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