Case Report: Successful Response to Intravenous Immunoglobulin and Steroid Pulses in a Renal Transplant Recipient With Severe Covid-19 Disease and Associated Acute Allograft Failure

Rosa-Guerrero, Pedro; Trujillo-Aguilera, Antonio; Molina, Juan; Navas, Ana; López-Martín, Cristina; Jurado, Aurora; Rodríguez‐Benot, Alberto; Rueda, Álvaro Torres De

doi:10.3389/fimmu.2021.671013

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…The use of lymphocyte-depleting antibodies can trigger hyperactive immune responses, which are sometimes termed “the cytokine storm”, due to strong lymphocytolysis. In this work, we used IL-2 and IL-6 as a proxy measure of lymphocytolysis and the development of a cytokine storm ( 38 – 40 ). pALG administration led to lower IL-2 (absolute) and IL-6 (relative) compared with rATG administration.…”

Section: Discussionmentioning

confidence: 99%

Porcine anti-human lymphocyte immunoglobulin depletes the lymphocyte population to promote successful kidney transplantation

Zhang

Zou

et al. 2023

Front. Immunol.

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IntroductionPorcine anti-human lymphocyte immunoglobulin (pALG) has been used in kidney transplantation, but its impacts on the lymphocyte cell pool remain unclear.MethodsWe retrospectively analyzed 12 kidney transplant recipients receiving pALG, and additional recipients receiving rabbit anti-human thymocyte immunoglobulin (rATG), basiliximab, or no induction therapy as a comparison group.ResultspALG showed high binding affinity to peripheral blood mononuclear cells (PBMCs) after administration, immediately depleting blood lymphocytes; an effect that was weaker than rATG but stronger than basiliximab. Single-cell sequencing analysis showed that pALG mainly influenced T cells and innate immune cells (mononuclear phagocytes and neutrophils). By analyzing immune cell subsets, we found that pALG moderately depleted CD4+T cells, CD8+T cells, regulatory T cells, and NKT cells and mildly inhibited dendritic cells. Serum inflammatory cytokines (IL-2, IL-6) were only moderately increased compared with rATG, which might be beneficial in terms of reducing the risk of untoward immune activation. During 3 months of follow-up, we found that all recipients and transplanted kidneys survived and showed good organ function recovery; there were no cases of rejection and a low rate of complications.DiscussionIn conclusion, pALG acts mainly by moderately depleting T cells and is thus a good candidate for induction therapy for kidney transplant recipients. The immunological features of pALG should be exploited for the development of individually-optimized induction therapies based on the needs of the transplant and the immune status of the patient, which is appropriate for non-high-risk recipients.

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Section: Discussionmentioning

confidence: 99%

Porcine anti-human lymphocyte immunoglobulin depletes the lymphocyte population to promote successful kidney transplantation

Zhang

Zou

et al. 2023

Front. Immunol.

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“…But its status has not been updated for 2 years. It was proved useful that high-dose intravenous immunoglobulin plus steroid pulses in treating a case of COVID-19 pneumonia patient with a single-kidney transplanted requiring mechanical ventilation and hemodialysis [162]. Sarilumab is a recombinant human immunoglobulin monoclonal antibody of IL6 alfa-receptor.…”

Section: Combination Therapy With Biomacromolecule and Small Moleculementioning

confidence: 99%

Combination Therapies against COVID-19

Luo¹,

Zheng²,

Zhang³

2022

Front. Biosci. (Landmark Ed)

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of Coronavirus disease 2019 (COVID-19), which was announced as a pandemic leading to devastating economic and medical burden worldwide. The virus attacks the organ system across the body by binding to its receptor (for example, angiotensin converting enzyme 2) on the surface of the host cell of various organs. The patients present with a variety of pathological symptoms ranging from fever, cough and cytokine storm to acute respiratory distress syndrome (ARDS). Many combination therapies have been developed to combat the disease, via blocking one or more processes of the viral life cycle and/or relieving host complications simultaneously. In this review, the progress of those combination therapies containing at least one small molecule is updated. We believe it'll provide significant inspiration for further development of treatment strategy against SARS-CoV-2, especially its mutant variants.

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“…Rosa-Guerrero et al described the success of the treatment in a case report. They used high-dose intravenous immunoglobulin (IVIG; 65 g/day) combined with steroid pulses (giving a high dose of steroid in a short time, 125 mg/day of 6-methylprednisolone) to treat SARS-CoV-2-infected kidney transplant recipients [ 59 ]. Such treatment can effectively remove inflammatory cytokines (ferritin, D-dimer, CRP, lactate dehydrogenase, and IL-6) in the plasma and maintain hemodynamic stabilization in a short period.…”

Section: Use Of Immunosuppressive Agents In Kidney Transplant Recipient With Covid-19mentioning

confidence: 99%

The Impact of SARS-CoV-2 Infection, and Application of Immunosuppressive Agents in Kidney Transplant Recipients Suffering from COVID-19

Tseng

Huang

et al. 2021

Pharmaceuticals

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In December 2019, the COVID-19 pandemic began to ravage the world quickly, causing unprecedented losses in human life and the economy. A statistical study revealed that the proportion of solid organ transplant (SOT) recipients with severe symptoms and deaths after being infected by SARS-CoV-2 is considerably higher than that of non-SOT recipients, and the prognosis is relatively poor. In addition, the clinical manifestation of SOT recipients suffering from COVID-19 is different from that of general COVID-19 patients. Acute kidney injury (AKI) is a common complication in COVID-19 patients, and it is likely more common among SOT recipients infected with SARS-CoV-2. Clinical experts consider that SOT recipients have long-term treatment with immunosuppressants, and the comorbidities are driven by a high rate of severe symptoms and mortality. Orthotopic kidney allograft transplantation is an effective treatment for patients suffering from end-stage kidney disease/kidney failure through which they can easily extend their life. Indeed, kidney transplant recipients have suffered significant damage during this pandemic. To effectively reduce the severity of symptoms and mortality of kidney transplant recipients suffering from COVID-19, precise application of various drugs, particularly immunosuppressants, is necessary. Therefore, herein, we will collate the current clinical experience of treating COVID-19 infection in kidney transplant recipients and discuss the adjustment of patients using immunosuppressive agents in the face of COVID-19.

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Case Report: Successful Response to Intravenous Immunoglobulin and Steroid Pulses in a Renal Transplant Recipient With Severe Covid-19 Disease and Associated Acute Allograft Failure

Cited by 5 publications

References 23 publications

Porcine anti-human lymphocyte immunoglobulin depletes the lymphocyte population to promote successful kidney transplantation

Porcine anti-human lymphocyte immunoglobulin depletes the lymphocyte population to promote successful kidney transplantation

Combination Therapies against COVID-19

The Impact of SARS-CoV-2 Infection, and Application of Immunosuppressive Agents in Kidney Transplant Recipients Suffering from COVID-19

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