Induction immunosuppression and outcome in kidney transplant recipients with early COVID-19 after transplantation
Por:
Toapanta, N, Jimenez, S, Molina-Gomez, M, Maruri-Kareaga, N, Llinas-Mallol, L, Villanego, F, Facundo, C, Rodriguez-Ferrero, M, Montero, N, Vazquez-Sanchez, T, Gutierrez-Dalmau, A, Beneyto, I, Franco, A, Hernandez-Vicente, A, Perez-Tamajon, ML, Martin, P, Ramos-Verde, AM, Castaneda, Z, Bestard, O, Moreso, F
Publicada:
28 oct 2022
Ahead of Print:
1 abr 2022
Resumen:
Coronavirus disease 2019 (COVID-19) in kidney transplant recipients has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplant recipients developing COVID-19 during the early period after transplantation. We included kidney transplant recipients with <6 months with a functioning graft diagnosed with COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation; 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups but patients receiving thymoglobulin were more sensitized [calculated panel reactive antibodies (cPRAs) 32.7 +/- 40.8% versus 5.6 +/- 18.5%] and were more frequently retransplants (30% versus 4%). Recipients >65 years of age treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), respectively, and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)], respectively, and the poorest survival [mortality rate 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05) and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05), respectively]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox regression model adjusted for comorbidities. Thus thymoglobulin should be used with caution in older recipients during the present pandemic era.
Filiaciones:
Toapanta, N:
Univ Autonoma Barcelona, Kidney Transplant Unit, Dept Nephrol,Vall dHebron Barcelona Hosp Campus, Vall dHebron Hosp Univ,Vall dHebron Inst Recerca, Barcelona, Spain
Jimenez, S:
Hosp Univ Ramon y Cajal, Dept Nephrol, Kidney Transplant Unit, Madrid, Spain
Molina-Gomez, M:
Hosp Badalona Germans Trias & Pujol, Dept Nephrol, Kidney Transplant Unit, Badalona, Spain
Maruri-Kareaga, N:
Hosp Univ Cruces, Dept Nephrol, Kidney Transplant Unit, Baracaldo, Spain
Llinas-Mallol, L:
Hosp Mar, Dept Nephrol, Kidney Transplant Unit, Barcelona, Spain
Villanego, F:
Hosp Univ Puerta del Mar, Dept Nephrol, Kidney Transplant Unit, Cadiz, Spain
Facundo, C:
Fundacio Puigvert, Dept Nephrol, Kidney Transplant Unit, Barcelona, Spain
Rodriguez-Ferrero, M:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, Kidney Transplant Unit, Madrid, Spain
Montero, N:
Hosp Univ Bellvitge, Kidney Transplant Unit, Dept Nephrol, Barcelona, Spain
Vazquez-Sanchez, T:
Hosp Univ Reg Malaga, Dept Nephrol, Kidney Transplant Unit, Malaga, Spain
Gutierrez-Dalmau, A:
Hosp Univ Miguel Servet, Dept Nephrol, Kidney Transplant Unit, Zaragoza, Spain
Beneyto, I:
Hosp Univ la Fe, Dept Nephrol, Kidney Transplant Unit, Valencia, Spain
Franco, A:
Hosp Gen Univ Alicante, Dept Nephrol, Kidney Transplant Unit, Alicante, Spain
Hernandez-Vicente, A:
Hosp Univ 12 Octubre, Dept Nephrol, Kidney Transplant Unit, Madrid, Spain
Perez-Tamajon, ML:
Hosp Univ Canarias, Dept Nephrol, Kidney Transplant Unit, Tenerife, Spain
Martin, P:
Clin Univ Navarra, Dept Nephrol, Kidney Transplant Unit, Pamplona, Spain
Ramos-Verde, AM:
Fdn Jimenez Diaz, Dept Nephrol, Kidney Transplant Unit, Madrid, Spain
Castaneda, Z:
Univ Autonoma Barcelona, Kidney Transplant Unit, Dept Nephrol,Vall dHebron Barcelona Hosp Campus, Vall dHebron Hosp Univ,Vall dHebron Inst Recerca, Barcelona, Spain
Bestard, O:
Univ Autonoma Barcelona, Kidney Transplant Unit, Dept Nephrol,Vall dHebron Barcelona Hosp Campus, Vall dHebron Hosp Univ,Vall dHebron Inst Recerca, Barcelona, Spain
Moreso, F:
Univ Autonoma Barcelona, Kidney Transplant Unit, Dept Nephrol,Vall dHebron Barcelona Hosp Campus, Vall dHebron Hosp Univ,Vall dHebron Inst Recerca, Barcelona, Spain
gold, Green Accepted
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