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1.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i745, 2022.
Article in English | EMBASE | ID: covidwho-1915805

ABSTRACT

BACKGROUND AND AIMS: COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. METHOD: Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. RESULTS: A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. CONCLUSION: Thymoglobulin should be used with caution in older recipients during the present pandemic era.

2.
Clinical Kidney Journal ; : 19, 2022.
Article in English | Web of Science | ID: covidwho-1758707

ABSTRACT

Novel coronavirus disease infection (COVID-19) was declared a global pandemic in March 2020 and since then has become a major public health problem. The prevalence of COVID-19 infection and acute kidney injury (AKI) is variable depending on several factors such as race/ethnicity, and severity of illness. The pathophysiology of renal involvement in COVID-19 infection is not entirely clear but it could be in part explained by the viral tropism in the kidney parenchyma. AKI in COVID-19 infection can be either by direct invasion of the virus, or as a consequence of immunologic response. Diverse studies have focused on the effect of COVID-19 on glomerulonephritis (GN) patients or the "novo" GN;however, the effect of COVID-19 in acute tubulointerstitial nephritis (ATIN) has been scarcely studied. In this article, we present five cases with different spectrums of COVID-19 infection and ATIN that may suggest that recent diagnosis of ATIN is accompanied with a worse clinical prognosis in comparison with long-term diagnosed ATIN.

4.
Journal of the International Aids Society ; 24:16-16, 2021.
Article in English | Web of Science | ID: covidwho-1529279
5.
American Journal of Transplantation ; 21(SUPPL 4):298, 2021.
Article in English | EMBASE | ID: covidwho-1494429

ABSTRACT

Purpose: The emerged COVID-19 pandemic caused by SARS-CoV-2 has paralyzed the world, due to its high infectivity and fatal outcomes, especially among more vulnerable individuals. While description of protective humoral and T-cell immune responses has been reported among immunocompetent (IC) individuals, its characterization and determinants of poorer outcomes among the at-risk Solid Organ Transplant (SOT) patient population has not been thoroughly investigated. Methods: SARS-CoV-2-specific serological and functional T-cell immune responses against main immunogenic antigens were tracked in 28 SOT recipients during acute infection and over the following 40 days of convalescence and were compared to 16 IC patients admitted with similar moderate/severe COVID-19. Results: We show a more severe polyfunctional T-cell and serological impairment in SOT at the infection onset as compared to IC individuals, especially against membrane antigen. Worse clinical outcomes (need of mechanical ventilation or death) more frequently occurred within SOT and were associated with a significantly impaired Th1 polarized immune response to antigens spike and membrane. Nonetheless, SOT achieved robust serological and functional Th1 and Th2 immune responses at convalescence, similarly to those of IC patients. Conclusions: Our data show a delay of serological and functional T-cell immune activation to SARS-CoV-2 in SOT, which may entail poorer clinical outcomes.

6.
Nephrology Dialysis Transplantation ; 36(SUPPL 1):i540, 2021.
Article in English | EMBASE | ID: covidwho-1402528

ABSTRACT

BACKGROUND AND AIMS: Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. METHOD: Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. RESULTS: At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes neither de novo donor specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. CONCLUSION: Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.

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