By writer to www.renalandurologynews.com
Kidney transplant recipients look like at excessive danger for average to extreme COVID-19 as a result of immunosuppressive drugs and pre-existing circumstances, in line with Enver Akalin, MD, and colleagues from Montefiore Medical Heart within the Bronx, New York.
At their heart, 36 kidney transplant recipients (75% transplanted with a deceased donor kidney; 72% male; median age 60 years; 42% Hispanic; 39% black) examined constructive for COVID-19 from March 16 to April 1, 2020. Total, 94% had hypertension, 69% had diabetes mellitus, and 17% had coronary heart illness — circumstances related to extra extreme COVID-19 an infection. A 3rd of sufferers had smoking historical past.
Fewer transplant recipients than anticipated initially offered with fever (58%) and 22% had diarrhea. Immune cell counts have been decrease within the transplant recipients than within the basic inhabitants with COVID-19, and their situation deteriorated extra quickly; irritation was rampant. Of the 36 sufferers, 28 (78%) of the transplant recipients have been admitted to Montefiore’s hospital, the place chest radiographs revealed viral pneumonia in 27 (96%) and 11 (39%) required mechanical air flow. Six sufferers (21%) obtained renal alternative remedy for acute kidney damage.
For immunosuppression, 35 sufferers (97%)
had been receiving tacrolimus, 34 (94%) prednisone, and 31 (86%) mycophenolate
mofetil or mycophenolic acid. Montefiore clinicians withdrew an antimetabolite from
24 (86%) of the hospitalized sufferers and tacrolimus from 6 (21%).
For COVID-19 therapy, 24 sufferers (86%)
obtained investigational hydroxychloroquine. Six sufferers (21%) obtained the
CCR5 inhibitor leronlimab (PRO 140, CytoDyn) on a compassionate-use foundation, and
2 (7%) obtained the interleukin-6 receptor antagonist tocilizumab. Practically half
of sufferers obtained the antibiotic azithromycin. Sufferers with d-dimer ranges
greater than 3.zero μg/mL obtained the anticoagulant apixaban.
Of the 36 sufferers, 10 (28%) died. Amongst 11 intubated sufferers, 7 (64%) died. Sufferers who died at dwelling had lately obtained T-cell-depleting antithymocyte globulin. Ten hospitalized sufferers have been finally discharged.
“Our outcomes present a really excessive early
mortality amongst kidney-transplant recipients with Covid-19 — 28% at Three weeks as
in contrast with the reported 1% to five% mortality amongst sufferers with Covid-19 in
the final inhabitants who’ve undergone testing in america and the
reported eight to 15% mortality amongst sufferers with Covid-19 who’re older than 70
years of age,” Dr Akalin and his colleagues said.
Akalin E, Azzi Y, Bartash R, et al. Covid-19 and kidney transplantation [April 24, 2020]. N Engl J Med. doi: 10.1056/NEJMc2011117