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López V, Mazuecos A, Villanego F, López-Oliva M, Alonso A, Beneyto I, Crespo M, Díaz-Corte C, Franco A, González-Roncero F, Guirado L, Jiménez C, Juega J, Llorente S, Paul J, Rodríguez-Benot A, Ruiz JC, Sánchez-Fructuoso A, Torregrosa V, Zárraga S, Rodrigo E, Hernández D. Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients. Nefrologia 2023; 43:531-545. [PMID: 37957107 DOI: 10.1016/j.nefroe.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2023] Open
Abstract
SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country. This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.
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Affiliation(s)
- Verónica López
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, Spain.
| | | | | | | | - Angel Alonso
- Servicio de Nefrología, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - Isabel Beneyto
- Servicio de Nefrología, Hospital Universitario Politécnico La Fe, Valencia, Spain
| | - Marta Crespo
- Servicio de Nefrología, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN), Barcelona, Spain
| | - Carmen Díaz-Corte
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Antonio Franco
- Servicio de Nefrología, Hospital de Alicante, Alicante, Spain
| | | | - Luis Guirado
- Servicio de Nefrología, Fundación Puigvert, REDinREN RD16/0009/0019, Barcelona, Spain
| | | | - Javier Juega
- Servicio de Nefrología, Hospital Trias i Pujol, REDinREN RD16/0009/0032, Barcelona, Spain
| | - Santiago Llorente
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Javier Paul
- Servicio de Nefrología, Hospital Miguel Servet, Zaragoza, Spain
| | - Alberto Rodríguez-Benot
- Servicio de Nefrología, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Juan Carlos Ruiz
- Servicio de Nefrología, Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, Cantabria, Spain
| | - Ana Sánchez-Fructuoso
- Servicio de Nefrología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sofía Zárraga
- Servicio de Nefrología, Hospital de Cruces, Bilbao, Vizcaya, Spain
| | - Emilio Rodrigo
- Servicio de Nefrología, Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, Cantabria, Spain
| | - Domingo Hernández
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, Spain
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Candel FJ, Salavert M, Lorite Mingot D, Manzano Crespo M, Pérez Portero P, Cuervo Pinto R. Reduction in the risk of progression of solid organ transplant recipients infected by SARS-CoV-2 treated with monoclonal antibodies. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:380-391. [PMID: 37089055 PMCID: PMC10336315 DOI: 10.37201/req/023.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023]
Abstract
Recipients of solid organ transplants (SOT) are at higher risk of infection by SARS-CoV-2 virus especially due to chronic immunosuppression therapy and frequent multiple comorbid conditions. COVID-19 is a potentially life-threatening disease in SOT recipients, with an increased likelihood of progressing to severe disease, with the need of hospitalization, admission to the intensive care unit (ICU) and mechanical ventilatory support. This article presents an updated review of different aspects related to the outcome of COVID-19 in SOT recipients. In nvaccinated SOT recipients, COVID-19 is associated with a high mortality rate, in-patient care and ICU admission, and impaired graft function or rejection in severe disease. In vaccinated SOT recipients even after full vaccination, there is a reduction of the risk of mortality, but the course of COVID-19 may continue to be severe, influenced by the time from transplant, the net state of immunosuppression and having suffered graft rejection or dysfunction. SOT recipients develop lower immunity from mRNA vaccines with suboptimal response. Treatment with mAbs provides favorable outcomes in non-hospitalized SOT recipients at high risk for severe disease, with lower rates of hospitalization, emergency department visits, ICU care, progression to severe disease, and death. However, broad vaccination and therapeutic options are required, particularly in light of the tendency of the SARS-CoV-2 virus to adapt and evade both natural and vaccine-induced immunity.
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Affiliation(s)
- F J Candel
- Dr. Francisco Javier Candel. Enfermedades Infecciosas y Microbiología Clínica, Coordinación de Trasplantes, Banco de Tejidos, Hospital Clínico San Carlos, Hospital Clínico Universitario San Carlos, Madrid, Spain.
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Farhadian N, Farhadian M, Zamanian MH, Taghadosi M, Vaziri S. Sotrovimab therapy in solid organ transplant recipients with mild to moderate COVID-19: a systematic review and meta-analysis. Immunopharmacol Immunotoxicol 2022:1-22. [DOI: 10.1080/08923973.2022.2160733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Negin Farhadian
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Hossein Zamanian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Taghadosi
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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López V, Mazuecos A, Villanego F, López-Oliva M, Alonso A, Beneyto I, Crespo M, Díaz-Corte C, Franco A, González-Roncero F, Guirado L, Jiménez C, Juega J, Llorente S, Paul J, Rodríguez-Benot A, Ruiz JC, Sánchez-Fructuoso A, Torregrosa V, Zárraga S, Rodrigo E, Hernández D. [Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients.]. Nefrologia 2022; 43:S0211-6995(22)00174-6. [PMID: 36405492 PMCID: PMC9664833 DOI: 10.1016/j.nefro.2022.11.001] [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: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country.This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.
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Affiliation(s)
- Verónica López
- Unidad de Gestión Clínica de Nefrología. Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, España
| | | | | | | | - Angel Alonso
- Servicio de Nefrología. Complejo Hospitalario A Coruña, España
| | - Isabel Beneyto
- Servicio de Nefrología. Hospital Universitario Politécnico La Fe, Valencia, España
| | - Marta Crespo
- Servicio de Nefrología. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, España. RD16/0009/0013 (ISCIII FEDER REDinREN), España
| | - Carmen Díaz-Corte
- Servicio de Nefrología. Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, España
| | - Antonio Franco
- Servicio de Nefrología. Hospital de Alicante, Alicante, España
| | | | - Luis Guirado
- Servicio de Nefrología. Fundación Puigvert, REDinREN RD16/0009/0019, Barcelona, España
| | | | - Javier Juega
- Servicio de Nefrología. Hospital Trias i Pujol, REDinREN RD16/0009/0032, Barcelona, España
| | - Santiago Llorente
- Servicio de Nefrología. Hospital Virgen de la Arrixaca, Murcia, España
| | - Javier Paul
- Servicio de Nefrología. Hospital Miguel Servet, Zaragoza, España
| | - Alberto Rodríguez-Benot
- Servicio de Nefrología. Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, España
| | - Juan Carlos Ruiz
- Servicio de Nefrología. Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, España
| | - Ana Sánchez-Fructuoso
- Serivicio de Nefrología. Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | | | - Sofía Zárraga
- Servicio de Nefrología. Hospital de Cruces, Bilbao, España
| | - Emilio Rodrigo
- Servicio de Nefrología. Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, España
| | - Domingo Hernández
- Unidad de Gestión Clínica de Nefrología. Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, España
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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.
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