Intravenous Immunoglobulin and Favipiravir treatment for A Kidney Transplant Patient with Severe Covid-19 Pneumonia

Early and late results of intravenous immunoglobulin as potential adjuvant therapies in critically ill COVID-19 patients: a retrospective cohort study

Introduction: Intravenous immunoglobulin (IVIG), which is one of the adjuvant therapy strategies, has been started to be used in critically ill COVID-19 patients due to its anti-inflammatory and immunomodulatory effects. Material and Method: In our study, it was aimed to evaluate the effect of IVIG used in critically ill COVID-19 patients in the intensive care unit on early laboratory findings and late lung damage. Twenty-two critically ill COVID-19 patients who met the inclusion criteria were included in the study. Laboratory data of the patients who received 0.4 gr/kg/day IVIG for 5 days were analyzed before the treatment and on the 1st and 5th days of the treatment. For the percentage of injured lung areas was evaluated with chest CT. Results: Respiratory rate and CRP decreased with IVIG, while an increase was observed in PaO2/FiO2, WBC, lymphocyte count, D-Dimer and fibrinogen values, which was statistically significant (p

Coronavirus-19 infection in kidney transplant recipients: A comprehensive review

The COVID-19 pandemic has disrupted health care across the globe. Since the beginning of the pandemic, there have been substantial changes in the approach toward kidney transplantation and management of the virus in transplant recipients. Chronic immunosuppression and comorbidities in renal transplant recipients place them at risk during the pandemic. Data on the risk factors, presentation, and management of kidney transplant patients have become more robust over time. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search on all published studies that investigated COVID-19 infection in kidney transplant recipients. This comprehensive review summarizes the current literature on the epidemiology, clinical features, complications, graft outcomes, and current management of COVID-19 infection in kidney transplant recipients. We further summarize published literature on immunization in kidney transplant recipients.

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, a huge number of case reports, case series, and consecutively various systematic reviews have been published reporting on morbidity and mortality risk connected with SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even for the expert reader.

METHODS

We performed a structured literature review comprising electronic databases, transplant journals, and literature from previous systematic reviews covering the entire year 2020. From 164 included articles, we identified 3451 cases of SARS-CoV-2-infected SOT recipients.

RESULTS

Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after coronavirus disease 2019 (COVID-19) was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT recipients.

CONCLUSIONS

COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT recipients with COVID-19.

COVID-19 pneumonia in kidney transplant recipients: A promising treatment algorithm in the absence of a disease-specific drug

There is no consensus on the management of coronavirus disease 2019 (COVID‐19) and modification of immunosuppressive therapy in kidney transplant recipients (KTRs). In this study, we examined the clinical outcome of our KTRs with COVID‐19 disease, who were treated with a broad‐spectrum anti‐inflammatory protocol. This protocol is essentially composed of intravenous immunoglobulin +/‐ tocilizumab in KTRs with severe COVID‐19 pneumonia. Among 809 KTRs, 64 patients diagnosed with COVID‐19 disease between April 2020 and February 2021, were evaluated. Twenty‐nine patients with pneumonia confirmed by chest computed tomography (CCT) were hospitalized. The treatment protocol included high‐dose intravenous methylprednisolone, favipiravir, enoxaparin, and empirical antibiotics. Patients with pneumonic involvement of more than 25% on CCT with or without respiratory failure were given a total of 2 g/kg intravenous immunoglobulin (IVIg) therapy. Nonresponders received tocilizumab, an interleukin‐6 receptor antibody. Of the 29 patients with pneumonia, 6 were treated in other hospitals. These six patients did not receive IVIg and 5 of them deceased. In our center, IVIg treatment was applied to 15 of 23 patients. Seven of them required tocilizumab. Respiratory parameters improved significantly in all but one patient after IVIg ± tocilizumab treatment. The mortality rate was 6.6% in patients who received IVIg therapy and 35.7% in those who did not (p = 0.08). The mortality rate was higher in patients who received treatment in external centers (2.2% vs. 26.3%; p = 0.0073). The treatment of KTRs with severe COVID‐19 pneumonia in organ transplant centers with significant experience yields better results. The administration of broad‐spectrum anti‐inflammatory treatment in this patient group was safe and provided excellent outcomes.