Kolonko A, Kuczaj AA, Musialik J, Słabiak-Błaż N, Hrapkowicz T, Przybyłowski P, Więcek A. Clinical insights into the role of immunosuppression and its disturbances in solid organ transplant recipients with coronavirus disease 2019.
Pol Arch Intern Med 2021;
132. [PMID:
34779600 DOI:
10.20452/pamw.16139]
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Abstract
BACKGROUND
The ongoing COVID-19 pandemic has disproportionately affected patients who have undergone solid organ transplantation.
OBJECTIVES
To analyze a cohort of transplant recipients in our practice who developed COVID-19, with a focus on immunosuppressive regimen, tacrolimus blood levels, clinical course, and patient and graft outcomes.
METHODS
During the first 12 months of the pandemic, we identified patients diagnosed with SARS-CoV-2 infection among our ambulatory cohort, including kidney, liver, and heart transplant recipients. Baseline and follow-up data concerning graft function, immunosuppression details, and patient and graft outcomes were analyzed.
RESULTS
Of 2091 ambulatory patients, 201 (9.6%) with diagnosed SARS-CoV-2 infection were identified, including 112 kidney, 56 heart, and 33 liver transplant recipients. COVID-19 cases were significantly more common among those who had recently undergone kidney (during 2015-2020) or heart transplantation (during 2020) than earlier recipients. Additionally, blood levels of tacrolimus measured during or shortly after COVID-19 in 23 kidney graft recipients were significantly increased (median increase, 76.1%; interquartile range: 47.4%-109.4%) relative to pre-dose trough levels, but liver function values were not concomitantly elevated, necessitating a tacrolimus dose reduction in 73.9% of these patients.
CONCLUSIONS
In our cohort of transplant recipients, we found substantial disturbances of tacrolimus metabolism in kidney recipients, which may play a role in the worsening of kidney function during SARS-CoV-2 infection. In addition, we found that infections were more common with recent kidney or heart transplantation, and results suggest the potential importance of immunosuppressive regimen strength for SARS-CoV-2 infection-related morbidity.
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