1
|
Simone S, Pronzo V, Pesce F, Bavaro DF, Infante B, Mercuri S, Schirinzi A, Panaro A, Conte E, Belati A, Troise D, Pontrelli P, Conserva F, Gallo P, Panico M, Spilotros M, Lucarelli G, Saracino A, Stallone G, Di Serio F, Ditonno P, Gesualdo L. Safety and efficacy of tixagevimab/cilgavimab for pre-exposure prophylaxis in kidney transplant recipients: a multicenter retrospective cohort study. J Nephrol 2024:10.1007/s40620-024-01889-9. [PMID: 38780697 DOI: 10.1007/s40620-024-01889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Immunocompromised patients show an impaired vaccine response and remain at high risk of severe COVID-19, despite vaccination. Neutralizing monoclonal antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed for prophylaxis and treatment. The combination tixagevimab/cilgavimab (AZD7442) has been authorized for emergency use as pre-exposure prophylaxis for COVID-19, but data on safety and efficacy in kidney transplant recipients during the Omicron period are limited. METHODS We conducted a multicenter retrospective cohort study including 253 kidney transplant recipients, of whom 98 were treated with tixagevimab/cilgavimab 150 mg/150 mg and 155 who received only four doses of the BNT162b2 mRNA vaccine. RESULTS Only 13.3% of patients developed SARS-CoV-2 infection after the administration of tixagevimab/cilgavimab; in comparison, 34.2% of patients had been infected after the fourth dose of vaccine (p = 0.00013). Most infected patients in the AZD7442 group remained asymptomatic (92.3% vs 54.7%), 7.7% had mild symptoms and none had severe disease, need for hospitalization or died, while in the control group, 9.4% of patients had moderate or severe disease (p = 0.04). Using Kaplan-Meier curves we demonstrated that the controls presented early infection compared to the AZD7442 group (p = 0.000014). No changes in eGFR or proteinuria, assessed before and after the administration, were observed. CONCLUSIONS In conclusion, our study showed that tixagevimab/cilgavimab 150/150 mg is effective and safe in preventing infection and severe disease when administered to patients with weak or no response to COVID-19 vaccine.
Collapse
Affiliation(s)
- Simona Simone
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Virginia Pronzo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Infante
- Renal Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvia Mercuri
- Renal Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Antonella Panaro
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Eleonora Conte
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Belati
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Dario Troise
- Renal Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paola Pontrelli
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Conserva
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Gallo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena Panico
- Renal Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Spilotros
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Stallone
- Renal Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
| |
Collapse
|
2
|
Zheng Z, Sun H, Hu X, Xuan Z, Fu M, Bai Y, Du Y, Liu B, Sui X, Zheng J, Shao C. Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19. Front Med (Lausanne) 2024; 11:1287836. [PMID: 38633308 PMCID: PMC11021598 DOI: 10.3389/fmed.2024.1287836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 posed a massive threat to human life and caused an economic upheaval worldwide. Kidney transplant recipients (KTRs) became susceptible to infection during the COVID-19 pandemic owing to their use of immunosuppressants, resulting in increased hospitalization and mortality rates. Although the current epidemic situation is alleviated, the long-term existence of COVID-19 still seriously threatens the life and health of KTRs with low immunity. The Omicron variant, a highly infectious but less-pathogenic strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns among transplant physicians regarding managing KTRs diagnosed with this variant. However, currently, there are no clear and unified guidelines for caring for KTRs infected with this variant. Therefore, we aimed to summarize the ongoing research on drugs that can treat Omicron variant infections in KTRs and explore the potential of adjusting immunotherapy strategies to enhance their responsiveness to vaccines. Herein, we discuss the situation of KTRs since the emergence of COVID-19 and focus on various prevention and treatment strategies for KTRs since the Omicron variant outbreak. We hope to assist physicians in managing KTRs in the presence of long-term COVID-19 variants.
Collapse
Affiliation(s)
- Zeyuan Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huimin Sun
- Central Laboratory, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoyan Hu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuodong Xuan
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Meiling Fu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yang Bai
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yifan Du
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bin Liu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiuyuan Sui
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Shao
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
3
|
Benotmane I, Legendre C, Caillard S. Challenges Faced by Solid Organ Transplant Recipients During the COVID-19 Pandemic in France: Historical Insights and Key Takeaways. Transplantation 2024; 108:819-822. [PMID: 38526428 DOI: 10.1097/tp.0000000000004924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Ilies Benotmane
- Department of Nephrology, Dialysis, and Transplantation, Strasbourg University Hospital, Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Christophe Legendre
- Department of Nephrology-Transplantation, Hôpital Necker, Université de Paris, Paris, France
| | - Sophie Caillard
- Department of Nephrology, Dialysis, and Transplantation, Strasbourg University Hospital, Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| |
Collapse
|
4
|
Stiasny K, Weseslindtner L, Heinzel A, Camp JV, Oberbauer R, Reindl-Schwaighofer R. SARS-CoV-2 Omicron BA.1/BA.2 Neutralization up to 8 Weeks After PrEP With Sotrovimab or Cilgavimab/Tixagevimab. Transpl Int 2022; 35:10906. [PMID: 36578452 PMCID: PMC9790897 DOI: 10.3389/ti.2022.10906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Karin Stiasny
- Center of Virology, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Heinzel
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,*Correspondence: Andreas Heinzel,
| | - Jeremy V. Camp
- Center of Virology, Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Zhang X, Weng R, Liu F, Xie Y, Jin Y, Li Q, Huang G, Chen J, Wang J, Shen H, Fu H, Mao J. COVID-19 Breakthrough Infections in Vaccinated Kidney Transplant Recipients. Vaccines (Basel) 2022; 10:vaccines10111911. [PMID: 36423007 PMCID: PMC9696595 DOI: 10.3390/vaccines10111911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality among kidney transplant recipients (KTRs). The administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is the only reliable strategy to prevent COVID-19 and alleviate the severity of COVID-19 in this particular population. The aim of this article was to evaluate the clinical protection by vaccines (breakthrough infections, deaths, and hospitalizations) in KTRs. There were 135 KTRs with COVID-19 breakthrough infections for whom patient-level data were available in PubMed and Web of Science. There was a male predominance (61.4%), 97 were given the standard vaccination regimen, and 38 received three or four doses of the vaccine. The median age was 59.0 (IQR: 49.0−69.0) years. A total of 67 patients were hospitalized, and 10 patients died. In 72.6% of cases, triple-maintenance immunosuppression was employed. The deceased patients were older than the survivors (p < 0.05); an age over 60 years was a risk factor for death (p < 0.05). The KTRs with booster vaccines had a longer time interval from the last vaccine to COVID-19 infection and lower hospitalization rates than the individuals who received the standard vaccination regimen (33.3% vs. 54.8%, p < 0.05). The hospitalized patients were older than the outpatients (p < 0.05). Among 16,820 fully vaccinated or boosted KTRs from 14 centers, there were 633 breakthrough infections (3.58%) and 73 associated deaths (0.41%). The center-level breakthrough infection rates varied from 0.21% to 9.29%. These findings highlight the need for booster doses for KTRs. However, more research is needed to define the long-term effectiveness and immunogenicity of booster doses and to identify methods to boost the protective response to vaccination in these immunocompromised patients.
Collapse
Affiliation(s)
- Xiaojing Zhang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ruopeng Weng
- Department of Gynecology and Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310007, China
| | - Fei Liu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yi Xie
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yanyan Jin
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Qiuyu Li
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guoping Huang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Junyi Chen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jingjing Wang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Huijun Shen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Haidong Fu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence:
| |
Collapse
|
6
|
What Is New in Prophylaxis and Treatment of COVID-19 in Renal Transplant Patients? A Report from an ESOT Meeting on the Topic. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
I should highlight that this manuscript is not a formal review on the topic, but a report from an ESOT meeting held on 22 June 2022. The assumption of immunosuppressants exposes kidney transplant recipients to the risk of infections, including COVID-19 infection. A transplant patient having COVID-19 infection raises several questions, including whether the immunosuppressive therapy should be reduced with the consequent risk of favoring acute rejections. Patient vaccination before transplantation is probably the gold standard to avoid the risk of COVID-19 infection after transplantation. In the case of transplant patients, three measures may be undertaken: vaccination, use of monoclonal antibodies and use of therapeutic antiviral small molecules. Concerning vaccination, it is still debated which one is the best and how many doses should be administered, particularly considering the new variants of the virus. The onset of virus variants has stimulated researchers to find new active vaccines. In addition, not all transplant patients develop antibodies. An alternative prophylactic measure to be principally used for patients that do not develop antibodies after vaccination is the use of monoclonal antibodies. These drugs may be administered as prophylaxis or in the early stage of the disease. Finally, the small antiviral molecules may be used again as prophylaxis or treatment. Their major drawbacks are their interference with immunosuppressive drugs and the fact that some of them cannot be administered to patients with low eGFR.
Collapse
|
7
|
Benotmane I, Velay A, Vargas GG, Olagne J, Cognard N, Heibel F, Braun-Parvez L, Martzloff J, Perrin P, Pszczolinski R, Moulin B, Fafi-Kremer S, Caillard S. A rapid decline in the anti-receptor-binding domain of the SARS-CoV-2 spike protein IgG titer in kidney transplant recipients after tixagevimab-cilgavimab administration. Kidney Int 2022; 102:1188-1190. [PMID: 35973595 PMCID: PMC9375643 DOI: 10.1016/j.kint.2022.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Ilies Benotmane
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France; Unité mixte de recherche (UMR) S1109 Labex Transplantex, Institut national de la santé et de la recherche médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France.
| | - Aurélie Velay
- Unité mixte de recherche (UMR) S1109 Labex Transplantex, Institut national de la santé et de la recherche médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France; Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - Gabriela-Gautier Vargas
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Jérôme Olagne
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Noëlle Cognard
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Françoise Heibel
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Laura Braun-Parvez
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Jonas Martzloff
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Peggy Perrin
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Romain Pszczolinski
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France; Unité mixte de recherche (UMR) S1109 Labex Transplantex, Institut national de la santé et de la recherche médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France
| | - Samira Fafi-Kremer
- Unité mixte de recherche (UMR) S1109 Labex Transplantex, Institut national de la santé et de la recherche médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France; Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, Strasbourg, France; Unité mixte de recherche (UMR) S1109 Labex Transplantex, Institut national de la santé et de la recherche médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France
| |
Collapse
|
8
|
Benotmane I, Velay A, Gautier-Vargas G, Olagne J, Obrecht A, Cognard N, Heibel F, Braun-Parvez L, Keller N, Martzloff J, Perrin P, Pszczolinski R, Moulin B, Fafi-Kremer S, Thaunat O, Caillard S. Breakthrough COVID-19 cases despite prophylaxis with 150 mg of tixagevimab and 150 mg of cilgavimab in kidney transplant recipients. Am J Transplant 2022; 22:2675-2681. [PMID: 35713984 PMCID: PMC9350296 DOI: 10.1111/ajt.17121] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
The cilgavimab-tixagevimab combination retains a partial in vitro neutralizing activity against the current SARS-CoV-2 variants of concern (omicron BA.1, BA.1.1, and BA.2). Here, we examined whether preexposure prophylaxis with cilgavimab-tixagevimab can effectively protect kidney transplant recipients (KTRs) against the omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of 150 mg tixagevimab and 150 mg cilgavimab, 39 (9.4%) developed COVID-19. With the exception of one case, all patients were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients (7.7%), respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n = 1). Viral neutralizing activity of the serum against the BA.1 variant was negative in the 12 tested patients, suggesting that this prophylactic strategy does not provide sufficient protection against this variant of concern. In summary, preexposure prophylaxis with cilgavimab-tixagevimab at the dose of 150 mg of each antibody does not adequately protect KTRs against omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential.
Collapse
Affiliation(s)
- Ilies Benotmane
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France,Inserm UMR S1109 Labex Transplantex Fédération de Médecine Translationnelle, Strasbourg University Strasbourg France,Ilies Benotmane, Department of Nephrology, Dialysis and Transplantation, Strasbourg University Hospital, 1 place de l’hôpital, Strasbourg 67091, France.
| | - Aurélie Velay
- Inserm UMR S1109 Labex Transplantex Fédération de Médecine Translationnelle, Strasbourg University Strasbourg France,Department of Virology Strasbourg University Hospital Strasbourg France
| | - Gabriela Gautier-Vargas
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Jérôme Olagne
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Augustin Obrecht
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Noëlle Cognard
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Françoise Heibel
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Laura Braun-Parvez
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Nicolas Keller
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Jonas Martzloff
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Peggy Perrin
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Romain Pszczolinski
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France
| | - Bruno Moulin
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France,Inserm UMR S1109 Labex Transplantex Fédération de Médecine Translationnelle, Strasbourg University Strasbourg France
| | - Samira Fafi-Kremer
- Inserm UMR S1109 Labex Transplantex Fédération de Médecine Translationnelle, Strasbourg University Strasbourg France,Department of Virology Strasbourg University Hospital Strasbourg France
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology Hospices Civils de Lyon, Edouard Herriot Hospital Lyon France
| | - Sophie Caillard
- Department of Nephrology, Dialysis and Transplantation Strasbourg University Hospital Strasbourg France,Inserm UMR S1109 Labex Transplantex Fédération de Médecine Translationnelle, Strasbourg University Strasbourg France
| |
Collapse
|
9
|
Del Bello A, Marion O, Izopet J, Kamar N. Can the COVID-19 Pandemic Improve the Management of Solid Organ Transplant Recipients? Viruses 2022; 14:v14091860. [PMID: 36146666 PMCID: PMC9500961 DOI: 10.3390/v14091860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Increased mortality due to SARS-CoV-2 infection was observed among solid organ transplant patients. During the pandemic, in order to prevent and treat COVID-19 infections in this context, several innovative procedures and therapies were initiated within a short period of time. A large number of these innovations can be applied and expanded to improve the management of non-COVID-19 infectious diseases in solid organ transplant patients and in the case of a future pandemic. In this vein, the present paper reviews and discusses medical care system adaptation, modification of immunosuppression, adjuvant innovative therapies, the role of laboratory expertise, and the prevention of infections as examples of such innovations.
Collapse
Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
| | - Jacques Izopet
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
- University Toulouse III—Paul Sabatier, 31000 Toulouse, France
- Laboratory of Virology, Toulouse Purpan University Hospital, 31300 Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
- University Toulouse III—Paul Sabatier, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-5-61-32-23-35; Fax: +33-5-61-32-39-89
| |
Collapse
|
10
|
Stevens KI, Frangou E, Shin JIL, Anders HJ, Bruchfeld A, Schönermarck U, Hauser T, Westman K, Fernandez-Juarez GM, Floege J, Goumenos D, Turkmen K, van Kooten C, McAdoo SP, Tesar V, Segelmark M, Geetha D, Jayne DRW, Kronbichler A. Perspective on COVID-19 vaccination in patients with immune-mediated kidney diseases: consensus statements from the ERA-IWG and EUVAS. Nephrol Dial Transplant 2022; 37:1400-1410. [PMID: 35244174 PMCID: PMC9383521 DOI: 10.1093/ndt/gfac052] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with immune-mediated kidney diseases are at increased risk of severe coronavirus disease 2019 (COVID-19). The international rollout of COVID-19 vaccines has provided varying degrees of protection and enabled the understanding of vaccine efficacy and safety. The immune response to COVID-19 vaccines is lower in most patients with immune-mediated kidney diseases; either related to immunosuppression or comorbidities and complications caused by the underlying disease. Humoral vaccine response, measured by the presence of antibodies, is impaired or absent in patients receiving rituximab, mycophenolate mofetil (MMF), higher doses of glucocorticoids and likely other immunosuppressants, such as cyclophosphamide. The timing between the use of these agents and administration of vaccines is associated with the level of immune response: with rituximab, vaccine response can only be expected once B cells start to recover and patients with transient discontinuation of MMF mount a humoral response more frequently. The emergence of new COVID-19 variants and waning of vaccine-induced immunity highlight the value of a booster dose and the need to develop mutant-proof vaccines. COVID-19 vaccines are safe, exhibiting a very low risk of de novo or relapsing immune-mediated kidney disease. Population-based studies will determine whether this is causal or coincidental. Such cases respond to standard management, including the use of immunosuppression. The Immunonephrology Working Group and European Vasculitis Society recommend that patients with immune-mediated kidney diseases follow national guidance on vaccination. Booster doses based on antibody measurements could be considered.
Collapse
Affiliation(s)
- Kate I Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Eleni Frangou
- Department of Nephrology, Limassol General Hospital, Limassol, Cyprus
| | - Jae I l Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Ulf Schönermarck
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Kerstin Westman
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | | | - Jürgen Floege
- Division of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, Patras University Hospital, Patras, Greece
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cees van Kooten
- Division of Nephrology and Transplant Medicine, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
11
|
Gandolfini I, Crespo M, Hellemans R, Maggiore U, Mariat C, Mjoen G, Oniscu GC, Peruzzi L, Sever MS, Watschinger B, Hilbrands L. Issues regarding COVID-19 in kidney transplantation in the era of the omicron variant: a commentary by the era descartes working group. Nephrol Dial Transplant 2022; 37:1824-1829. [PMID: 35746885 PMCID: PMC9278231 DOI: 10.1093/ndt/gfac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
The Omicron variant, which has become the dominant strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide, brings new challenges to preventing and controlling the infection. Moreover, the widespread implementation of vaccination policies before and after transplantation, and the development of new prophylactic and treatment strategies for coronavirus disease 2019 (COVID-19) over the past 12–18 months, has raised several new issues concerning kidney transplant recipients. In this special report, the ERA DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) Working Group addresses several questions related to everyday clinical practice concerning kidney transplant recipients and to the assessment of deceased and live kidney donors: what is the current risk of severe disease and of breakthrough infection, the optimal management of immunosuppression in kidney transplant recipients with COVID-19, the role of passive immunization and the efficacy of antiviral drugs in ambulatory patients, the management of drug-to-drug interactions, safety criteria for the use of SARS-CoV-2-positive donors, issues related to the use of T cell depleting agents as induction treatment, and current recommendations for shielding practices.
Collapse
Affiliation(s)
- Ilaria Gandolfini
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, Department of Nephrology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal transplantation, Centre Hospitalier Universitaire de Saint Etienne, Université Jean MONNET, Saint Etienne, France
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mehmet Sükrü Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Fernandes G, Devresse A, Scohy A, De Greef J, Yombi JC, Belkhir L, Darius T, Mourad M, Buemi A, Kabamba B, Goffin E, Kanaan N. Monoclonal Antibody Therapy in Kidney Transplant Recipients With Delta and Omicron Variants of SARS-CoV-2: A Single-Center Case Series. Kidney Med 2022; 4:100470. [PMID: 35493029 PMCID: PMC9042411 DOI: 10.1016/j.xkme.2022.100470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rationale & Objective Study Design Setting & Participants Results Limitations Conclusions
Collapse
|
13
|
Flahault A, Touchard J, Péré H, Ulrich L, Sabatier B, Veyer D, Lebeaux D, Thervet E. Breakthrough Omicron COVID-19 infections in patients receiving REGEN-Cov antibody combination. Kidney Int 2022; 101:824-825. [PMID: 35157894 PMCID: PMC8837470 DOI: 10.1016/j.kint.2022.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Adrien Flahault
- Service de Néphrologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France; Université de Paris, Paris, France.
| | - Justine Touchard
- Service de Pharmacie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Hélène Péré
- Service de Virologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Laetitia Ulrich
- Service de Néphrologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Brigitte Sabatier
- Service de Pharmacie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - David Veyer
- Service de Virologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Eric Thervet
- Service de Néphrologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France; Université de Paris, Paris, France
| |
Collapse
|
14
|
Tylicki L, Biedunkiewicz B, Ślizień Z, Muchlado M, Dębska-Ślizień A. Heterologous high dose SARS-CoV-2 mRNA vaccine booster may improve immune response in seronegative kidney transplant recipients. Arch Med Sci 2022; 18:1100-1102. [PMID: 35832697 PMCID: PMC9266872 DOI: 10.5114/aoms/150000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Three-dose mRNA vaccination against COVID-19 is unable to elicit a sufficient immune response in immunocompromised subjects. METHODS The aim of the study was to conduct a retrospective evaluation of the efficacy of a heterologous mRNA booster with mRNA-1273 in constantly seronegative kidney transplant recipients (KTRs) after three doses of the BNT162b2 mRNA vaccine. Twelve seronegative KTRs received a mRNA-1273 booster 5 months after the third dose of BNT162b2. RESULTS A total of 5 out of 12 patients (41.7%) seroconverted, with a mean titer of 353 BAU/ml. CONCLUSIONS The administration of a heterologous mRNA vaccine as a booster may be an effective alternative for achieving post-vaccination immunity in seronegative KTRs.
Collapse
Affiliation(s)
- Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Zuzanna Ślizień
- Medical students of the Medical University of Gdansk, Gdansk, Poland
| | - Marta Muchlado
- Medical students of the Medical University of Gdansk, Gdansk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|