Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 805
Filter
1.
urol. colomb. (Bogotá. En línea) ; 31(4): 170-176, 2022. ilus
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-2186455

ABSTRACT

Objetivo Describir la tasa de mortalidad de infección por coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, en inglés) y los factores de riesgo asociados a la severidad de la enfermedad en pacientes con trasplante renal de un centro del nordeste colombiano. Materiales y Métodos Estudio descriptivo de una cohorte de pacientes en seguimiento postrasplante renal, en el que se hizo una búsqueda retrospectiva de los que presentaron infección por SARS-CoV-2 entre marzo del 2020 y mayo del 2021. Para el análisis, se incluyeron los pacientes con infección confirmada mediante pruebas de reacción en cadena de la polimerasa (polymerase chain reaction, PCR, en inglés), de antígenos, o de anticuerpos. Se realizó un análisis descriptivo de las variables sociodemográficas y clínicas, y un análisis bivariado de los posibles factores asociados con el riesgo de mortalidad. Resultados Con un total de 307 individuos en seguimiento, se encontró una prevalencia del 14,3% (n = 44) de infección por enfermedad por coronavirus 2019 (coronavirus disease 2019, COVID-19, en inglés). La media de edad fue de 56 años, con predominio del género masculino. El esquema de inmunosupresión más frecuente fue micofenolato­tacrolimus­prednisona. Entre los pacientes infectados, la mortalidad fue del 34,1% (15/44), lo que representa el 4,8% de toda la población a estudio. Maás de la mitad de los pacientes requirieron hemodiálisis, y en el 86,7% fue necesario hacer ajustes en el esquema de inmunosupresión. Conclusión La prevalencia de infección por SARS-CoV-2 en nuestro grupo de trasplantes fue similar a la reportada por otros grupos de trasplante del país, y mayor a la de la población no trasplantada. El valor de creatinina previo a la infección, la edad y las comorbilidades se asociaron con un mayor riesgo de mortalidad.


Objective To describe the mortality related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk factors associated with disease severity in patients submitted to a kidney transplant from a center in northeastern Colombia. Materials and Methods The present is a descriptive study of a cohort of patients in follow-up care after kidney transplant, with a retrospective search for those who presented SARS-CoV-2 infection between March 2020 and May 2021. Patients with confirmed infection by polymerase chain reaction (PCR), antigens or antibodies tests were included for analysis. We performed a descriptive analysis of the sociodemographic and clinical variables as well as a bivariate analysis to evaluate the possible factors associated with the risk of mortality. Results With a total of 307 individuals in follow-up care, a prevalence of 14.3% (n = 44) of coronavirus disease 2019 (COVID-19) infection was found. The mean age of the sample was of 56 years, with a male predominance. The most frequent immunosuppression regimen was mycophenolate-tacrolimus-prednisone. Among the infected patients, the mortality rate was of 34.1% (15/44), representing 4.8% of the entire study population. More than half of the patients required hemodialysis, and 86.7% required adjustments to the immunosuppression regimen. Conclusion The prevalence of SARS-CoV-2 infection in our transplant group was similar to that reported by other transplant groups in the country and higher than among the non-transplanted population. The preinfection creatinine value, age, and comorbidities were associated with a higher risk of mortality.


Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis , Kidney Transplantation , Coronavirus , Severe Acute Respiratory Syndrome , SARS-CoV-2 , COVID-19 , Severity of Illness Index , Adaptation, Psychological , Polymerase Chain Reaction , Risk Factors , Immunosuppression Therapy , Antigens
2.
Front Immunol ; 13: 911738, 2022.
Article in English | MEDLINE | ID: covidwho-2198836

ABSTRACT

Introduction: Vaccination is an effective strategy for preventing SARS-CoV-2 infection and associated mortality. Renal Transplant Recipients (RTRs) are vulnerable to acquiring infection and high mortality due to their immunocompromised state. Varying responses to the different vaccines, depending on types of vaccines and population, have been reported. Vaccines supply is also limited. The current study evaluated the seroconversion rate after SARS-CoV-2 infection and 2 doses of either COVAXIN™ or COVISHIELD™ vaccination in RTR. Methods: The serum anti-SARS-CoV-2 spike protein neutralizing antibody titer was measured in 370 RTRs who acquired SARS-CoV-2 infection (n=172), yet not vaccinated; and those vaccinated with COVAXIN™ (n=78), and COVISHIELD™ (n=120) by chemiluminescence microparticle immunoassay methods from serum. Result: Overall, the seroconversion rate either after vaccination or infection was 85.13% (315/370). The vaccine-associated seroconversion was 80.30% (159/198). SARS-CoV-2 infection-associated seroconversion was 90.69% (156/172), COVISHIELD™ associated seroconversion was 79.2% (95/120), and COVAXIN™ associated seroconversion was 82.05% (64/78). The median IgG titer in the SARS-CoV-2 infection group was 646.50 AU/ml (IQR: 232.52-1717.42), in the COVAXIN™ group was 1449.75 AU/ml (IQR: 400.0-3068.55), and the COVISHIELD™ vaccination group was 1500.51 AU/ml (IQR: 379.47-4938.50). The seroconversion rate and antibody titers were similar irrespective of the place of sampling. Patient's age-associated seroconversion in <45 years was 88.01% (213/242), 45.1-60 years was 83.18% (94/113), and > 60 years was 58.3% (7/12). Conclusions: Both infection and vaccination induce robust antibody formation in RTRs. The seroconversion rate after SARS-CoV-2 infection was higher but with a lower antibody titer than vaccines. The vaccines, COVAXIN™ and COVISHIELD™, induce more elevated antibody titers than natural infection. The seroconversion rate and antibody titer in Indian RTRs appears to be better than in the western population, irrespective of their vaccination status.


Subject(s)
COVID-19 , Kidney Transplantation , Allografts , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Immunoglobulin G , Middle Aged , SARS-CoV-2 , Seroconversion , Tertiary Care Centers , Vaccination , Vaccines, Inactivated
3.
Transpl Int ; 35: 10721, 2022.
Article in English | MEDLINE | ID: covidwho-2154859

ABSTRACT

Kidney transplant recipients (KTR) are at increased risk for COVID-19-associated complications. We aimed to describe the evolving epidemiology and outcome of PCR-documented SARS-CoV-2 infection in KTR followed at our institution from March 2020 to May 2022. The primary endpoint was hospitalization for COVID-19-related symptoms or death within 28 days from diagnosis. Overall, 243 cases were included of which 68 (28%) developed the primary outcome. A significant decrease in the incidence of the primary outcome was observed (p < 0.001, r -0.342) during the study period. Anti-Spike monoclonal antibodies (mAbs) were administered as early treatment (within 5-7 days of onset of symptoms) in 101 patients (14 with casirivimab/imdevimab and 87 with sotrovimab). Among 145 patients who had received at least one vaccination dose before infection, 109 patients were considered as adequately vaccinated. Multivariate analysis revealed that the Charlson Comorbidity Index (P 0.001; OR 1.28, CI 1.11-1.48) was associated with the primary outcome, while early administration of mAbs (P 0.032; OR 0.39, CI 0.16-0.92) was associated with a better outcome, but not infection during the period of the omicron variant predominance or adequate vaccination.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , Antibodies, Monoclonal/therapeutic use , Antibodies, Viral , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Transplant Recipients
5.
MMW Fortschr Med ; 164(Suppl 3): 10, 2022 Nov.
Article in German | MEDLINE | ID: covidwho-2149002
6.
Exp Clin Transplant ; 20(10): 908-916, 2022 10.
Article in English | MEDLINE | ID: covidwho-2144914

ABSTRACT

OBJECTIVES: Evidence on living donor kidney transplant procedures when both the donor and recipient have had a history of COVID-19 infection is scarce. MATERIALS AND METHODS: We retrospectively explored the protocol, outcomes, and follow-up of 64 donors and recipients of living donor kidney transplant who had recovered from COVID-19. This was a multicenter (n = 12) study from India that included transplants between October 29, 2020, and December 1, 2021. Induction and immunosuppression regimens forthose with different severities of COVID-19 were similar to standard practice. RESULTS: COVID-19 clinical severity ranged from asymptomatic/mild (not requiring oxygen therapy) in 49 recipients (77%) and 63 donors (95.4%) and moderate/severe (requiring oxygen therapy) in 15 recipients (23%) and 1 donor (4.6%). Mean wait time±SEM (SD)from firstdocumentednegative reverse transcriptase-polymerase chain reaction testto surgery for recipients and donors was 90.9 ± 9.27 (74.1) and 47 ± 4.5 (29.2) days, respectively. Six episodes (9.3%) of biopsy-proven acute rejection were reported at follow-up of 214 ± 14.8 (119) days and median of 227 (interquartile range, 109-309) days. The locally weighted scatter plot smoothing curve for creatinine during follow-up in donor-recipients pairs showed no trends of increased creatinine in the context of wait time from COVID-19 to transplant surgery. No graft loss, death, reactivation/reinfection, and complications related to surgery or COVID-19 were reported. CONCLUSIONS: Our report showed excellent outcomes and follow-up data of living donor kidney transplant in recovered donor-recipient pairs with the standard immunosuppression protocol. To our knowledge, this is the first and the largest study of donor-recipient living donor kidney transplant pairs when both donors and recipients had prior COVID-19.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , Living Donors , Graft Survival , Retrospective Studies , Creatinine , Treatment Outcome , SARS-CoV-2 , Oxygen
8.
Transplantation ; 106(12): 2399-2407, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2135880

ABSTRACT

BACKGROUND: The COVID-19 pandemic is the first sustained respiratory disease pandemic to arise since the start of solid organ transplantation (SOT). Prior studies have demonstrated that SOT recipients are at greater risk for severe complications of infection and are less likely to respond to vaccination. METHODS: The Scientific Registry of Transplant Recipients Standard Analysis Files was used to assess the cumulative excess mortality in SOT recipients during the first 20 mo of the pandemic. RESULTS: Compared with excess mortality rates in the US population (25.9 deaths/10 000; confidence interval [CI], 10.9-41.1), the excess mortality per 10 000 was higher in all SOT groups: kidney (188.5; CI, 150.7-225.6), lung (173.6; CI, 17-334.7), heart (123.7; CI, 56-191.4), and liver (105.1; CI, 64.6-146). The higher rates persisted even with attempts to control for population age structure and renal allograft failure. Excess mortality was also higher in Black (236.8; CI, 186.1-287) and Hispanic (256.9; CI, 208.1-305.2) organ recipients compared with other racial and ethnic groups in the Scientific Registry of Transplant Recipients and compared with the Black and Hispanic populations in the United States. CONCLUSIONS: Studies of excess mortality provide insight into the health and survival of specialized populations like SOT recipients during major health events like the COVID-19 pandemic.


Subject(s)
COVID-19 , Kidney Transplantation , Organ Transplantation , United States/epidemiology , Humans , Transplant Recipients , Pandemics , Kidney Transplantation/adverse effects , Organ Transplantation/adverse effects
9.
Vnitr Lek ; 68(7): 444-448, 2022.
Article in English | MEDLINE | ID: covidwho-2114787

ABSTRACT

Kidney transplant recipients are a very vulnerable population at risk of severe course and death from Covid-19. Several antiviral drugs are now available for the treatment of nonhospitalized individuals with mild to moderate Covid-19 and hospitalized patients with severe disease. The combination of monoclonal antibodies is also available to be used as pre-exposure prophylaxis in elderly patients. Previously used monoclonal antibodies for post-exposure prophylaxis are no longer effective because of the new mutations and are no longer recommended. Although the immune response to Covid-19 vaccines is impaired in kidney transplant recipients, the effectiveness of the Covid-19 vaccines was described even in this immunocompromised group. Therefore vaccination, together with anti-epidemic measures, remains the most important tool to prevent Covid-19.


Subject(s)
COVID-19 Vaccines , COVID-19 , Kidney Transplantation , Aged , Humans , Antibodies, Monoclonal , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Kidney Transplantation/adverse effects , Vaccination
10.
Exp Clin Transplant ; 20(Suppl 1): 156-160, 2022 03.
Article in English | MEDLINE | ID: covidwho-2090786

ABSTRACT

OBJECTIVES: The new coronavirus SARS-CoV-2 (COVID-19) first appeared in Turkey in March 2020, spread rapidly, and caused many deaths. Although COVID-19 is mostly a respiratory disease, it can cause kidney and multiorgan failure in some cases. We believe that by sharing information about the course and effects of COVID-19 infection in kidney transplant recipients receiving long-term immunosuppressive therapy our understanding will improve. MATERIALS AND METHODS: Between March 2020 and October 2021, COVID-19 was researched in kidney transplant recipients under the age of 20 years who were followed at the Baskent University Transplantation Center. We documented the clinical characteristics and prognosis of pediatric kidney transplant recipients with COVID-19 disease. RESULTS: Our study group included 23 patients with COVID-19 infection from 215 pediatric kidney transplant recipients. The mean age of the patients was 14.6 ± 4.7 years; there were 9 female patients. The mean follow-up time posttransplant was 62.3 ± 43.2 months. In 13 patients (56.5%), fever was the most frequent symptom. Most patients (n = 18, 78%) had minor symptoms and recovered completely after receiving supportive treatment. Four patients (17%) required hospitalization. One was diagnosed with COVID-19 infection 1 week after being treated with rituximab for acute antibody-mediated rejection. That patient died because of significant lung disease and multiorgan failure. CONCLUSIONS: Despite the fact that most of our pediatric transplant recipients had mild symptoms of COVID-19, we believe that particular caution should be observed in patients who have recently received intensive immunosuppressive medications. As a result of potential new vaccines, national immunization programs, and the emergence of novel virus strains, the clinical picture may change in the future. We believe that, as information sharing increases, we will learn more about COVID-19 in renal transplant recipients.


Subject(s)
COVID-19 , Kidney Transplantation , Adolescent , Adult , Child , Female , Humans , Kidney , Kidney Transplantation/adverse effects , SARS-CoV-2 , Transplant Recipients , Treatment Outcome , Young Adult
11.
Viruses ; 14(11)2022 Oct 30.
Article in English | MEDLINE | ID: covidwho-2090371

ABSTRACT

BACKGROUND: COVID-19 severity is determined by cardiometabolic risk factors, which can be further aggravated by chronic immunosuppression in kidney transplant recipients (KTRs). We aimed to verify the main risk factors related to hypertension (HTN) that contribute to COVID-19 progression and mortality in that population. METHODS: Retrospective analysis of 300 KTRs from March 2020 to August 2020 in a single center. We compared the main outcomes between HTN (n = 225) and non-HTN (n = 75), including admission to the intensive care unit (ICU), development of acute kidney injury (AKI), need for invasive mechanical ventilation or oxygen, and mortality. RESULTS: Of the patients in the study, 57.3% were male, 61.3% were white, the mean age was 52.5 years, and 75% had HTN. Pre-existing HTN was independently associated with higher rates of mortality (32.9%, OR = 1.96, p = 0.036), transfer to the ICU (50.7%, OR = 1.94, p = 0.017), and AKI with hemodialysis (HD) requirement (40.4%, OR = 2.15, p = 0.011). In the hypertensive group, age, diabetes mellitus, heart disease, smoking, glycemic control before admission, C-reactive protein, lactate dehydrogenase, lymphocytes, and D-dimer were significantly associated with COVID-19 progression and mortality. Both lower basal and previous estimated glomerular filtration rates posed KTRs with HTN at greater risk for HD requirement. CONCLUSIONS: Therefore, the early identification of factors that predict COVID-19 progression and mortality in KTRs affected by COVID-19 contributes to therapeutic decisions, patient flow management, and allocation of resources.


Subject(s)
Acute Kidney Injury , COVID-19 , Hypertension , Kidney Transplantation , Humans , Male , Middle Aged , Female , Kidney Transplantation/adverse effects , Retrospective Studies , Transplant Recipients , Hypertension/epidemiology , Hypertension/etiology , Risk Factors , Cohort Studies
12.
Sci Rep ; 12(1): 17978, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2087300

ABSTRACT

In the general population with COVID-19, the male sex is an established risk factor for mortality, in part due to a more robust immune response to COVID-19 in women. Because patients on kidney function replacement therapy (KFRT) have an impaired immune response, especially kidney transplant recipients due to their use of immunosuppressants, we examined whether the male sex is still a risk factor for mortality among patients on KFRT with COVID-19. From the European Renal Association COVID-19 Database (ERACODA), we examined patients on KFRT with COVID-19 who presented between February 1st, 2020, and April 30th, 2021. 1204 kidney transplant recipients (male 62.0%, mean age 56.4 years) and 3206 dialysis patients (male 61.8%, mean age 67.7 years) were examined. Three-month mortality in kidney transplant recipients was 16.9% in males and 18.6% in females (p = 0.31) and in dialysis patients 27.1% in males and 21.9% in females (p = 0.001). The adjusted HR for the risk of 3-month mortality in males (vs females) was 0.89 (95% CI 65, 1.23, p = 0.49) in kidney transplant recipients and 1.33 (95% CI 1.13, 1.56, p = 0.001) in dialysis patients (pinteraction = 0.02). In a fully adjusted model, the aHR for the risk of 3-month mortality in kidney transplant recipients (vs. dialysis patients) was 1.39 (95% CI 1.02, 1.89, p = 0.04) in males and 2.04 (95% CI 1.40, 2.97, p < 0.001) in females (pinteraction = 0.02). In patients on KFRT with COVID-19, the male sex is not a risk factor for mortality among kidney transplant recipients but remains a risk factor among dialysis patients. The use of immunosuppressants in kidney transplant recipients, among other factors, may have narrowed the difference in the immune response to COVID-19 between men and women, and therefore reduced the sex difference in COVID-19 mortality risk.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , Female , Male , Middle Aged , Aged , Renal Dialysis , Kidney Transplantation/adverse effects , Sex Characteristics , Risk Factors , Immunosuppressive Agents/therapeutic use , Kidney
13.
Exp Clin Transplant ; 20(Suppl 4): 74-79, 2022 08.
Article in English | MEDLINE | ID: covidwho-2080822

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has hit the world in an almost unprecedented way. Patients with endstage chronic renal failure, who are on hemodialysis, with glomerulonephritis and complicated pyelonephritis and other nephrological diseases, were under constant close supervision of specialists, despite the existing difficulties for face-to-face contact between the patient and the doctor at our hospital in Tashkent, Uzbekistan, where primary detection and treatment of these patients were also actively conducted. Here, we report the features of the course of treatment for COVID-19 infection in patients who underwent kidney transplant living related donors during the global pandemic in Uzbekistan. MATERIALS AND METHODS: After a decree from the Cabinet of Ministers of the Republic of Uzbekistan in October 2017 for approval and regulations for related kidney and (or) liver lobe procedures, our center performed 609 kidney transplants from living related donors between 2017 and 2022, with 320 procedures during the pandemic. There were 228 transplant recipients with COVID-19 infections and COVID-19-associated pneumonia. RESULTS: Of total cases with COVID-19, 71% had moderate disease severity. Of patients who under went kidney transplant, 42% had pneumonia associated with COVID-19 infection. After lung damage was confirmed by multislice computed tomography of the lungs, patients were sent to the intensive care unit for appropriate treatment to ensure a quick recovery without possible complications to the graft. CONCLUSIONS: The Ministry of Health of the Republic of Uzbekistan indicated the possibility of treatment of patients with moderate and severe COVID-19 disease with monoclonal antibodies that block interleukin 6 receptors (tocilizumab and sarilumab). With timely detection of symptoms of COVID-19infection, treatment, and the use of prevention methods, kidney transplant recipients of living related donors had fewer complications of the disease than expected.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , Incidence , Pandemics , SARS-CoV-2 , Transplant Recipients , Treatment Outcome , Uzbekistan
14.
Transpl Int ; 35: 10677, 2022.
Article in English | MEDLINE | ID: covidwho-2080318

ABSTRACT

Protection of adult kidney transplant recipients against SARS-CoV2 was shown to be strongly impaired owing to low reactogenicity of available vaccines. So far, data on vaccination outcomes in adolescents are scarce due to later vaccination approval for this age group. We therefore comprehensively analyzed vaccination-specific humoral-, T- and B-cell responses in kidney transplanted adolescents aged 12-18 years in comparison to healthy controls 6 weeks after standard two-dose BNT162b2 ("Comirnaty"; Pfizer/BioNTech) vaccination. Importantly, 90% (18/20) of transplanted adolescents showed IgG seroconversion with 75% (15/20) developing neutralizing titers. Still, both features were significantly diminished in magnitude compared to controls. Correspondingly, spike-specific B cells were quantitatively reduced and enriched for non-isotype-class-switched IgD+27+ memory cells in patients. Whereas spike specific CD4+ T cell frequencies were similar in both groups, cytokine production and memory differentiation were significantly impaired in transplant recipients. Although our data identify limitations in all arms of vaccine-specific immunity, the majority of our adolescent patients showed robust humoral responses despite antimetabolite-based treatment being associated with poor vaccination outcomes in adults.


Subject(s)
COVID-19 , Kidney Transplantation , Adolescent , Adult , Antibodies, Viral , BNT162 Vaccine/administration & dosage , BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Humans , Immunity, Humoral , Kidney Transplantation/adverse effects , RNA, Viral , SARS-CoV-2 , Vaccination , Vaccines, Synthetic , mRNA Vaccines
16.
Vaccine ; 40(45): 6499-6511, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2076793

ABSTRACT

BACKGROUND: Vaccination of patients with chronic kidney disease (CKD) and kidney transplants (KTs) may achieve a less robust immune response. Understanding such immune responses is crucial for guiding current and future vaccine dosing strategies. METHODS: This prospective, observational study estimated the immunogenicity of humoral and cellular responses of two SARS-CoV-2 vaccines in different patient groups with CKD compared with controls. Secondary outcomes included adverse events after vaccination and the incidence of COVID-19 breakthrough infection, including illness severity. RESULTS: In total, 212 patients received ChAdOx1 nCoV-19 (89.62 %) or inactivated vaccines (10.38 %).The antibody response against the S protein was analyzed at T0 (before the first injection), T1 (before the second injection), and T2 (12 weeks after the second injection). Seroconversion occurred in 92.31 % of controls at T2 and in 100 % of patients with CKD, 42.86 % undergoing KT, 80.18 % of hemodialysis (HD), and 0 % of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at T2 of the ChAdOx1 nCoV-19 vaccine. Neutralizing antibody levels by surrogate virus neutralization test were above the protective level at T2 in each group. The KT group exhibited the lowest neutralizing antibody and T cell response. Blood groups O and vaccine type were associated with good immunological responses. After the first dose, 14 individuals (6.6 out of the total population experienced COVID-19 breakthrough infection. CONCLUSION: Immunity among patients with CKD and HD after vaccination was strong and comparable with that of healthy controls. Our study suggested that a single dose of the vaccine is not efficacious and delays may result in breakthrough infection. Some blood groups and types of vaccine can affect the immune response.


Subject(s)
Blood Group Antigens , COVID-19 , Kidney Transplantation , Renal Insufficiency, Chronic , Humans , COVID-19 Vaccines , COVID-19/prevention & control , SARS-CoV-2 , ChAdOx1 nCoV-19 , Prospective Studies , Vaccination , Antibodies, Neutralizing , Renal Insufficiency, Chronic/complications , Antibody Formation , Vaccines, Inactivated , Antibodies, Viral
17.
Viruses ; 14(10)2022 10 09.
Article in English | MEDLINE | ID: covidwho-2071830

ABSTRACT

BACKGROUND: Molnupiravir demonstrated an in vitro antiviral activity against positive-sense RNA viruses, including SARS-CoV-2. The study aimed to present the results of outpatient molnupiravir use in kidney transplant recipients and hemodialysis patients during the first months of 2022 in Poland. METHODS: The retrospective observational cohort study at one kidney transplant center included 36 patients diagnosed with COVID-19 with an automated nucleic acid amplification test on nasopharyngeal swab specimens. All patients received molnupiravir for home-based therapy at a dose of 800 mg every 12 h orally for 5 days. Both kidney transplant recipients (n = 16) and hemodialysis patients (n = 20) presented a lot of comorbidities with a Charlson comorbidity index of 4.1 and 5.1, respectively. RESULTS: Patients presented with fever, cough, and weakness followed by muscle and joint pain. Five kidney transplant recipients experienced acute kidney injury with a rise in serum creatinine level from 0.4 to 1.9 mg/dL. No serious side effects of molnupiravir therapy or interactions with immunosuppressive medications were observed. Symptoms of COVID-19 improved rapidly or resolved within 24-48 h of starting treatment. CONCLUSION: The study suggests the safety and efficacy of molnupiravir therapy alone early after the onset of SARS-CoV-2 infection, but further investigations should be performed to confirm our preliminary results. To the best of the authors' knowledge, it is the first published report on molnupiravir use in end-stage kidney disease (ESKD) patients on hemodialysis and the third concerning kidney transplant recipients.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , COVID-19/therapy , SARS-CoV-2 , Kidney Transplantation/adverse effects , Retrospective Studies , Outpatients , Creatinine , Transplant Recipients , Antiviral Agents/therapeutic use
18.
Int J Mol Sci ; 23(20)2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2071512

ABSTRACT

The vulnerable population of kidney transplant recipients (KTRs) are low responders to COVID-19 vaccines, so specific immune surveillance is needed. The interferon-gamma (IFN-γ) release assay (IGRA) is effective in assessing T cell-mediated immunity. We assessed SARS-CoV-2-directed T cell responses in KTRs with absent antibody production after a third dose of the mRNA-1273 vaccine, using two different IGRAs. A cohort of 57 KTRs, who were actively followed up, received a third dose of the mRNA-1273 vaccine. After the evaluation of humoral immunity to SARS-CoV-2, 14 seronegative patients were tested with two commercial IGRAs (SD Biosensor and Euroimmun). Out of 14 patients, one and three samples were positive by IGRAs with Euroimmun and SD Biosensor, respectively. The overall agreement between the two assays was 85.7% (κ = 0.444). In addition, multivariate linear regression analysis showed no statistically significant association between the IFN-γ concentration, and the independent variables analyzed (age, gender, years since transplant, total lymphocytes cells/mcl, CD3+ cells/mcl, CD3+ CD4+ cells/mcl, CD3+ CD8+ cells/mcl, CD19+ cells/mcl, CD3-CD16+CD56+ cells/mcl) (p > 0.01). In a vulnerable setting, assessing cellular immune response to complement the humoral response may be advantageous. Since the two commercial IGRAs showed a good agreement on negative samples, the three discordant samples highlight the need for further investigations.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , 2019-nCoV Vaccine mRNA-1273 , Interferon-gamma/analysis , T-Lymphocytes/chemistry , COVID-19 Vaccines , Antibody Formation , SARS-CoV-2 , COVID-19/prevention & control , Transplant Recipients , Antibodies, Viral
19.
Medicina (Kaunas) ; 58(10)2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2066244

ABSTRACT

A forty-seven-year-old recipient in late period after kidney transplantation with chronic estimated glomerular filtration rate (eGFR) 30 mL/min/1.73 m2, fully vaccinated against COVID-19 was diagnosed with SARS-CoV-2 infection in November 2021. After an initially mild course of the disease, he developed multiorgan failure requiring periodic respiratory and dialysis therapy. Covid-19 disease was complicated by multiple infections such Clostridioides difficile infection, Streptococcus epidermidis bacteriemia, Klebsiella pneumoniae and Candida glabrata urinary tract disease, cytomegalovirus infection and oral candidiasis. In a short period, he was readmitted to the hospital twice with recurrent Klebsiella pneumoniae urosepsis. One of those hospitalizations was also complicated by another COVID-19 infection that was confirmed with non-reactive neutralizing antibody. Due to severe infections the patient required individualized modification of immunotherapy; however, due to their recurrence it was finally decided to be discontinued. The patient was also reintroduced to hemodialysis therapy and no infections occurred since then.


Subject(s)
COVID-19 , Kidney Transplantation , Male , Humans , Middle Aged , COVID-19/complications , RNA, Viral , SARS-CoV-2 , Kidney Transplantation/adverse effects , Antibodies, Neutralizing
20.
Transplantation ; 106(12): 2408-2415, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2063139

ABSTRACT

BACKGROUND: Kidney transplant recipients are at a higher risk to develop more severe clinical forms of coronavirus disease 2019 (COVID-19), perhaps increasing the risk of presenting its long-term clinical complications, labeled as Long-COVID. METHODS: This single-center, observational, prospective study included adult kidney transplant recipients with COVID-19 confirmed by reverse transcription polymerase chain reaction between March 20, 2020, and May 31, 2021, who were alive and with functioning graft 3 mo after the onset of symptoms. The prevalence of Long-COVID was investigated by a phone survey using a structured questionnaire of organic symptoms. Adjusted multivariable logistic regression models were used to investigate independent risk factors. RESULTS: Of 1741 patients who developed COVID-19, 465 died, and 37 returned to dialysis. Of the 1239 eligible patients, 780 (63%) answered the survey during the window period. The mean age was 48 ± 12 y, 41% were women, and the mean time from transplantation was 8 ± 6 y. During acute illness, 45% needed hospitalization. Long-COVID was identified in 214 (27%) of the subjects, with body aches being the most prevalent symptom (44%). Of 233 who provided working status, 17% did not return to work within 3 mo. No baseline characteristics or infection-related variables predicted Long-COVID; actually, the number of symptoms in the acute illness was the only independent risk factor identified (hazard ratio, 1.12; 95% confidence interval, 1.02-1.22). CONCLUSION: In this cohort of kidney transplant recipients, Long-COVID was prevalent and associated with a reduced return to work. The burden of acute phase symptoms was the only risk factor associated with Long-COVID.


Subject(s)
COVID-19 , Kidney Transplantation , Adult , Humans , Female , Middle Aged , Male , COVID-19/epidemiology , Kidney Transplantation/adverse effects , Longitudinal Studies , Prospective Studies , Prevalence , Acute Disease , Transplant Recipients , Cohort Studies
SELECTION OF CITATIONS
SEARCH DETAIL