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1.
BMJ Open ; 12(4): e061864, 2022 04 15.
Article in English | MEDLINE | ID: covidwho-1794490

ABSTRACT

INTRODUCTION: Regulatory T cell (Treg) therapy has been demonstrated to facilitate long-term allograft survival in preclinical models of transplantation and may permit reduction of immunosuppression and its associated complications in the clinical setting. Phase 1 clinical trials have shown Treg therapy to be safe and feasible in clinical practice. Here we describe a protocol for the TWO study, a phase 2b randomised control trial of Treg therapy in living donor kidney transplant recipients that will confirm safety and explore efficacy of this novel treatment strategy. METHODS AND ANALYSIS: 60 patients will be randomised on a 1:1 basis to Treg therapy (TR001) or standard clinical care (control). Patients in the TR001 arm will receive an infusion of autologous polyclonal ex vivo expanded Tregs 5 days after transplantation instead of standard monoclonal antibody induction. Maintenance immunosuppression will be reduced over the course of the post-transplant period to low-dose tacrolimus monotherapy. Control participants will receive a standard basiliximab-based immunosuppression regimen with long-term tacrolimus and mycophenolate mofetil immunosuppression. The primary endpoint is biopsy proven acute rejection over 18 months; secondary endpoints include immunosuppression burden, chronic graft dysfunction and drug-related complications. ETHICS AND DISSEMINATION: Ethical approval has been provided by the National Health Service Health Research Authority South Central-Oxford A Research Ethics Committee (reference 18/SC/0054). The study also received authorisation from the UK Medicines and Healthcare products Regulatory Agency and is being run in accordance with the principles of Good Clinical Practice, in collaboration with the registered trials unit Oxford Clinical Trials Research Unit. Results from the TWO study will be published in peer-reviewed scientific/medical journals and presented at scientific/clinical symposia and congresses. TRIAL REGISTRATION NUMBER: ISRCTN: 11038572; Pre-results.


Subject(s)
Kidney Transplantation , T-Lymphocytes, Regulatory , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/adverse effects , Kidney Transplantation/methods , Living Donors , Randomized Controlled Trials as Topic , State Medicine , Tacrolimus/therapeutic use
2.
Intern Med ; 61(4): 585-589, 2022 Feb 15.
Article in English | MEDLINE | ID: covidwho-1690565

ABSTRACT

With expansion of the COVID-19 pandemic, reports of post-COVID-19 interstitial lung disease (ILD) have been emerging. However, there are few reports regarding treatment. Some reports indicate that corticosteroids are effective for post-COVID-19 ILD, but the use of long-term corticosteroid carries risks of side effects. We administered tacrolimus to an elderly patient with post-COVID-19 ILD who suffered a respiratory failure relapse during steroid tapering. The respiratory status improved with tacrolimus in the post-acute phase, but pulmonary fibrosis progressed in the late phase. Tacrolimus may be effective for treating post-COVID-19 ILD in the post-acute phase, but it does not halt progression of pulmonary fibrosis.


Subject(s)
COVID-19 , Lung Diseases, Interstitial , Aged , Humans , Lung , Lung Diseases, Interstitial/epidemiology , Pandemics , SARS-CoV-2 , Tacrolimus/therapeutic use
3.
Daru ; 30(1): 59-66, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1648469

ABSTRACT

PURPOSE: To examine the impact of the COVID-19 pandemic on calcineurin inhibitors and related prescriptions for community patients in England. METHODS: Data from all primary-care patients who had calcineurin inhibitors prescriptions, dispensed in the community in England were included. Descriptive statistics and interrupted time series analysis over 27 months (15 months before and 12 months after 1st lockdown) was evaluated. RESULTS: Descriptive statistics show that mean values have declined since the pandemic's onset. Over the 27 months: mean Tacrolimus 865,045 doses, standard deviation (SD) 76,147 doses, with 95% CI 834,923, 895,168, (min 567,508, max 1,010,900), ciclosporin 315,496 doses, SD 40,094, 95% CI 299,635, 331,356 (min 191,281, max 382,253) and sirolimus 21,384 doses, SD 2,610, 95% CI 20,352, 22,417 (min 13,022, max 26,156). Analysis of variance between the pre- and post- periods show significant variations in quantities of tacrolimus F 7.432, p = 0.012, ciclosporin F 33.147, p < 0.001 and sirolimus F 18.596, p < 0.001 (1df), mirrored in price analysis. The Interrupted Time Series (ARIMA Modelling) shows declining trends. After the pandemic's onset, a statistically significant downward trend in quantity for tacrolimus p = 0.008 is observed, with an estimated monthly decline of 14,524 doses, ciclosporin p = 0.185, with an estimated decline of 2,161 doses and sirolimus p = 0.002 with an estimated decline of 485 doses, along with declining prices. CONCLUSION: A decrease in prescription medicines use raises concerns for the care of (renal) transplant patients. Patients are encouraged to discuss their planned care with their doctor, secure supplies and remain adherent to their medication.


Subject(s)
COVID-19 , Calcineurin Inhibitors , COVID-19/drug therapy , COVID-19/epidemiology , Calcineurin Inhibitors/therapeutic use , Cohort Studies , Communicable Disease Control , Cyclosporine/therapeutic use , Graft Rejection/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Pandemics , Prescriptions , Primary Health Care , Sirolimus/therapeutic use , Tacrolimus/therapeutic use
4.
BMC Gastroenterol ; 22(1): 22, 2022 Jan 15.
Article in English | MEDLINE | ID: covidwho-1636917

ABSTRACT

BACKGROUND: Therapy regimens used in patients with inflammatory Bowel Disease (IBD) have been associated with enhanced risk of viral infections or viral reactivation. Moreover, it is uncertain whether IBD patients have increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or infected patients may have an increased risk for severe coronavirus disease 2019 (Covid-19). Managing severe acute flare in ulcerative colitis during the Covid-19 pandemic is a challenge for clinicians and their patients. The results of the published studies mainly report on the role of the prior medication, but not how to treat severe acute flare of IBD patients with severe Covid-19 pneumonia. CASE PRESENTATION: We report the case of a 68-year-old patient with a long history of ulcerative colitis. He was initially admitted to an external hospital because of severe acute flare. The initiation of a high-dose oral cortisone therapy did not improve the clinical symptoms. During the inpatient treatment, he was tested positive for SARS-CoV-2. At admission to our hospital the patient showed severe flare of his ulcerative colitis and increased Covid-19 symptoms. A cortisone-refractory course was noticed. After detailed multidisciplinary risk-benefit assessment, we initiated an intravenous tacrolimus therapy and dose of prednisolone was tapered gradually. After clinical response, the therapy was adjusted to infliximab. Additionally, the Covid-19 pneumonia was kept under control despite immunosuppression and the patient could be discharged in clinical remission. CONCLUSIONS: This case suggest the use of tacrolimus as a bridging therapeutic option for severe acute, cortisone refractory ulcerative colitis in Covid-19 patients. Nevertheless, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined. Further data for IBD patients under calcineurin inhibitor therapy are urgently needed.


Subject(s)
COVID-19 , Colitis, Ulcerative , Cortisone , Aged , Colitis, Ulcerative/complications , Colitis, Ulcerative/drug therapy , Humans , Male , Pandemics , Remission Induction , SARS-CoV-2 , Tacrolimus/therapeutic use
7.
Intern Med ; 61(4): 585-589, 2022 Feb 15.
Article in English | MEDLINE | ID: covidwho-1555883

ABSTRACT

With expansion of the COVID-19 pandemic, reports of post-COVID-19 interstitial lung disease (ILD) have been emerging. However, there are few reports regarding treatment. Some reports indicate that corticosteroids are effective for post-COVID-19 ILD, but the use of long-term corticosteroid carries risks of side effects. We administered tacrolimus to an elderly patient with post-COVID-19 ILD who suffered a respiratory failure relapse during steroid tapering. The respiratory status improved with tacrolimus in the post-acute phase, but pulmonary fibrosis progressed in the late phase. Tacrolimus may be effective for treating post-COVID-19 ILD in the post-acute phase, but it does not halt progression of pulmonary fibrosis.


Subject(s)
COVID-19 , Lung Diseases, Interstitial , Aged , Humans , Lung , Lung Diseases, Interstitial/epidemiology , Pandemics , SARS-CoV-2 , Tacrolimus/therapeutic use
8.
Cornea ; 41(2): 252-253, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1505854

ABSTRACT

PURPOSE: The purpose of this study was to report a case of acute corneal epithelial rejection of living-related conjunctival limbal allograft (LR-CLAL) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. OBSERVATIONS: A 27-year-old woman developed acute epithelial rejection of LR-CLAL 2 weeks after receiving the SARS-CoV-2 vaccine. She received the LR-CLAL transplant 4 years and 7 months previously and had a stable clinical course with no history of rejection. She had an ABO blood group and human leukocyte antigen compatible donor, no systemic comorbidities, and no rejection risk factors. CONCLUSIONS: The novel SARS-CoV-2 vaccine upregulates the immune system to produce an adaptive immune response. The SARS-CoV-2 vaccine may potentially be associated with increased risk of rejection in those with ocular surface transplants.


Subject(s)
/adverse effects , Epithelium, Corneal/pathology , Graft Rejection/etiology , Limbus Corneae/cytology , Living Donors , Stem Cell Transplantation , Vaccination/adverse effects , Acute Disease , Administration, Ophthalmic , Administration, Oral , Adult , Allografts , COVID-19/prevention & control , Conjunctiva/cytology , Female , Glucocorticoids/therapeutic use , Graft Rejection/diagnosis , Graft Rejection/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/therapeutic use , Ophthalmic Solutions , Slit Lamp Microscopy , Tacrolimus/therapeutic use , Visual Acuity/physiology
11.
Clin J Gastroenterol ; 14(3): 842-845, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1118282

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in 2019; thereafter, the COVID-19 outbreak became a health emergency of international concern. The impact of COVID-19 on liver-transplant recipients is unclear. Thus, it is currently unknown whether liver-transplant recipients are at a higher risk of developing complications related to COVID-19. Here, we report the case of liver-transplant recipients who were infected with SARS-CoV-2. A 20-year-old man who had undergone living-donor liver transplantation from his father at 5 years of age because of congenital biliary atresia was referred to our hospital for SARS-CoV-2 infection. Chest computed tomography did not show any abnormalities; however, laboratory results revealed liver dysfunction. He received tacrolimus as maintenance therapy that was continued at the same dose. He has not developed severe pulmonary disease and was discharged after 10 days of hospitalization. Limited data are available on post-transplant patients with COVID-19, and this case of a young patient without metabolic comorbidities did not show any association of severe COVID-19 under tacrolimus treatment. The progression of COVID-19 in liver-transplant recipients is complex, and COVID-19 risk should be evaluated in each patient until the establishment of optimal guidelines.


Subject(s)
COVID-19/diagnosis , Immunosuppressive Agents/therapeutic use , Liver Transplantation/adverse effects , Postoperative Complications/drug therapy , SARS-CoV-2/isolation & purification , Tacrolimus/therapeutic use , Adult , COVID-19 Testing , Humans , Immunocompromised Host , Living Donors , Male , Postoperative Complications/diagnosis , Postoperative Complications/etiology , SARS-CoV-2/immunology , Transplant Recipients , Treatment Outcome , Young Adult
13.
Transplant Proc ; 53(4): 1187-1193, 2021 May.
Article in English | MEDLINE | ID: covidwho-1081930

ABSTRACT

BACKGROUND: Kidney transplant recipients (KTR) are considered high-risk for morbidity and mortality from coronavirus disease 2019 (COVID-19). However, some studies did not show worse outcomes compared to non-transplant patients and there is little data about immunosuppressant drug levels and secondary infections in KTR with COVID-19. Herein, we describe our single-center experience with COVID-19 in KTR. METHODS: We captured KTR diagnosed with COVID-19 between March 1, 2020 and May 18, 2020. After exclusion of KTR on hemodialysis and off immunosuppression, we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by age and sex (controls). RESULTS: Eleven KTR were hospitalized and matched with 44 controls. One KTR and 4 controls died (case fatality rate: 9.1%). There were no significant differences in length of stay or clinical outcomes between KTR and controls. Tacrolimus or sirolimus levels were >10 ng/mL in 6 out of 9 KTR (67%). Bacterial infections were more frequent in KTR (36.3%), compared with controls (6.8%, P = .02). CONCLUSIONS: In our small case series, unlike earlier reports from the pandemic epicenters, the clinical outcomes of KTR with COVID-19 were comparable to those of non-transplant patients. Calcineurin or mammalian target of rapamycin inhibitor (mTOR) levels were high. Bacterial infections were more common in KTR, compared with controls.


Subject(s)
COVID-19/diagnosis , Kidney Transplantation , Adult , Aged , Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19/virology , Case-Control Studies , Female , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Length of Stay , Male , Middle Aged , Pandemics , SARS-CoV-2/isolation & purification , Sirolimus/therapeutic use , TOR Serine-Threonine Kinases/metabolism , Tacrolimus/therapeutic use , Treatment Outcome
14.
Clin Transplant ; 35(4): e14221, 2021 04.
Article in English | MEDLINE | ID: covidwho-1043988

ABSTRACT

The influence of patient characteristics and immunosuppression management on COVID-19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single-center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID-19 between 03/15/2020 and 05/15/2020. Patients were followed from the date of admission up to 1 month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 ml/min/1.73 m2 were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR = 2.05; 1.04-4.04), peak D-dimer (OR = 1.20; 1.04-1.39), and peak white blood cell count (OR = 1.11; 1.02-1.21) were all associated with mortality among KTRs hospitalized for COVID-19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p < .01). Conversely, immunosuppression intensity and degree of reduction following COVID-19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient-specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID-19.


Subject(s)
COVID-19/mortality , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/mortality , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Female , Graft Rejection/epidemiology , HIV Infections , Humans , Male , Middle Aged , Mycophenolic Acid/therapeutic use , Retrospective Studies , Risk Factors , Tacrolimus/therapeutic use , Transplant Recipients
15.
Transplant Proc ; 53(4): 1202-1206, 2021 May.
Article in English | MEDLINE | ID: covidwho-1014862

ABSTRACT

Kidney transplant recipients who develop coronavirus disease 2019 (COVID-19) are at increased risk of life-threatening illness, which often requires reducing immunosuppression despite the potential risk of causing an allograft rejection. Herein, we describe the clinical presentation and course of a kidney transplant recipient who acquired COVID-19 and was hospitalized with severe symptoms and hypoxemia. Upon admission, the patient was found to have elevated de novo donor-specific antibodies (DSA) yielding a positive cytotoxicity crossmatch and concurrent elevated plasma donor-derived cell-free DNA (dd-cfDNA) level, indicating a possible ongoing rejection despite improvement in his serum creatinine. Because of persistent positive COVID-19 tests and stable serum creatinine, a kidney allograft biopsy was initially deferred and his dd-cfDNA and DSA were monitored closely postdischarge. Three months later, because of persistent elevated dd-cfDNA and positive DSA, a kidney allograft biopsy was performed, which showed chronic active antibody-mediated rejection. Accordingly, the patient was treated with intravenous immunoglobulin and his maintenance immunosuppressive regimen was increased.


Subject(s)
COVID-19/diagnosis , Graft Rejection/prevention & control , Kidney Transplantation , Antibodies/blood , Antibodies/immunology , COVID-19/complications , COVID-19/virology , Cell-Free Nucleic Acids/blood , Creatinine/blood , Graft Rejection/diagnosis , HLA-DR7 Antigen/immunology , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/blood , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Oxygen Inhalation Therapy , SARS-CoV-2/isolation & purification , Tacrolimus/blood , Tacrolimus/therapeutic use
16.
Transplant Proc ; 53(4): 1207-1210, 2021 May.
Article in English | MEDLINE | ID: covidwho-989339

ABSTRACT

Immunocompromised populations are at great risk of the current 2020 global emergency of coronavirus disease 2019 (COVID-19), and treatment of kidney transplant recipients with COVID-19 is currently not declared. Hence, the purpose of the study is to set a clear treatment regimen. We report here a therapeutic course of 2 patients who underwent transplant surgery in March 2020 and got infected soon after. Since the transplant, these 2 patients have received triple maintenance immunosuppressive therapy with oral tacrolimus, mycophenolate mofetil (MMF), and prednisone, and they have been regularly followed up at our hospital. The tacrolimus trough level was between 10 and 12 ng/mL. After the diagnosis of COVID-19, MMF was stopped and the tacrolimus dose was reduced so that blood level was between 4 and 6 ng/mL. The first patient was a 30-year-old man who, despite being treated with hydroxychloroquine, favipiravir, oseltamivir, and azithromycin therapy, died because of the presence of other comorbidities. The second case was a 58-year-old man who fully recovered from COVID-19 pneumonia with treatment with methylprednisolone, MMF, azithromycin, favipiravir, hydroxychloroquine, and reduction in immunosuppression dosage. This reflects the importance of using glucocorticoids in the treatment of COVID-19 along with other medications and the decreased mortality rate associated with their use.


Subject(s)
COVID-19/diagnosis , Kidney Transplantation , Adult , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/virology , Glucocorticoids/therapeutic use , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Mycophenolic Acid/therapeutic use , SARS-CoV-2/isolation & purification , Tacrolimus/therapeutic use , Withholding Treatment
17.
Transplant Proc ; 53(4): 1211-1214, 2021 May.
Article in English | MEDLINE | ID: covidwho-989338

ABSTRACT

Coronavirus disease 2019 (COVID-19) is associated with high morbidity and mortality worldwide in both the general population and kidney transplant recipients. Acute kidney injury is a known complication of COVID-19 and appears to most commonly manifest as acute tubular injury on renal biopsy. Coagulopathy associated with COVID-19 is a known but poorly understood complication that has been reported to cause thrombotic microangiopathy on rare occasions in native kidneys of patients with COVID-19. Here, we report the first case of biopsy-proven thrombotic microangiopathy in a kidney transplant recipient with COVID-19 who developed acute pancreatitis and clinical features of microangiopathic hemolytic anemia. The patient recovered with supportive care alone.


Subject(s)
COVID-19/diagnosis , Kidney Transplantation/adverse effects , Pancreatitis/etiology , Thrombotic Microangiopathies/etiology , COVID-19/complications , COVID-19/virology , Creatinine/blood , Female , Humans , Kidney/pathology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Middle Aged , Pancreatitis/diagnosis , Platelet Count , SARS-CoV-2/isolation & purification , Tacrolimus/blood , Tacrolimus/therapeutic use , Thrombotic Microangiopathies/diagnosis , Transplantation, Homologous/adverse effects
18.
Gastroenterology ; 160(4): 1151-1163.e3, 2021 03.
Article in English | MEDLINE | ID: covidwho-965554

ABSTRACT

BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.


Subject(s)
COVID-19/complications , Immunosuppressive Agents/therapeutic use , Liver Transplantation/adverse effects , SARS-CoV-2 , Tacrolimus/therapeutic use , Adult , Age Factors , Aged , Comorbidity , Female , Hospitalization , Humans , Liver Transplantation/mortality , Male , Middle Aged , Proportional Hazards Models , Thrombosis/prevention & control
19.
Turk J Med Sci ; 51(2): 428-434, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-922877

ABSTRACT

Background/aim: We aimed to identify clinical settings of renal transplant patients with COVID-19. Materials and methods: In this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented. Results: Twenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/ day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients. Conclusion: Renal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.


Subject(s)
COVID-19/physiopathology , Glucocorticoids/therapeutic use , Graft Rejection/prevention & control , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , Adult , COVID-19/immunology , COVID-19/therapy , Deprescriptions , Dexamethasone/therapeutic use , Disease Progression , Everolimus/therapeutic use , Female , Hospital Mortality , Hospitalization , Humans , Length of Stay , Male , Methylprednisolone/therapeutic use , Middle Aged , Mycophenolic Acid/therapeutic use , Renal Dialysis , Respiration, Artificial , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2 , Sepsis/physiopathology , Tacrolimus/therapeutic use
20.
Transpl Infect Dis ; 23(2): e13500, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-916948

ABSTRACT

There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/therapy , Glucocorticoids/therapeutic use , Graft Rejection/prevention & control , HIV Infections/drug therapy , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Adult , Anti-Bacterial Agents/therapeutic use , Atovaquone/therapeutic use , CD4 Lymphocyte Count , CD4-CD8 Ratio , COVID-19/complications , COVID-19/immunology , Dideoxynucleosides/therapeutic use , Female , HIV Infections/complications , HIV Infections/immunology , HIV-1/genetics , Humans , Immunocompromised Host/immunology , Lamivudine/therapeutic use , Male , Middle Aged , Mycophenolic Acid/therapeutic use , Pneumonia, Pneumocystis/prevention & control , Prednisolone/therapeutic use , RNA, Viral , Raltegravir Potassium/therapeutic use , SARS-CoV-2 , Tacrolimus/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
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