Case series of six kidney transplanted patients with COVID‐19 pneumonia treated with tocilizumab

Abstract

Severe acute respiratory syndrome coronavirus 2 (named SARS CoV-2/COVID-19) is a novel pandemic infectious disease, which emerged in Wuhan, China, in late December 2019 and spread rapidly worldwide. 1,2 At the time we are writing (05/10/2020), in Italy there are about 219 000 patients infected, 28 600 only in Piedmont, our region. 3 Clinically, the disease is characterized with fever, cough, dyspnea, diarrhea, and eventually respiratory failure. 4,5 According to their intrinsic frailty and comorbidities, transplanted patients were considered a high-risk population. 6,7 Tocilizumab (TCZ), a humanized monoclonal antibody against interleukin-6 (IL-6) receptor widely adopted in adult rheumatoid arthritis and also used as rescue therapy for chronic antibody-mediated rejection in kidney transplantation, 8 has been recently registered for the treatment of severe or life-threatening chimeric antigen receptor T-cell induced cytokine release syndrome (CRS) in adult and pediatric patients. 9 In this context, because the development of acute respiratory distress syndrome (ARDS) in COVID-19 pneumonia has been associated with activation of the immune system and consequent cytokine storm with high levels of IL-6, some initial reports suggested a beneficial role of this drug, 10,11 also in solid organ transplanted patients. 12 Herein, we reported our experience in 6 kidney transplanted patients treated with TCZ after occurrence of COVID-19 infection.

Kidney transplant recipients infected by COVID‐19: Review of the initial published experience

“…These trends are comparable to the demographics of the general KTx populations. 57 Many studies (31/37) reported the time from KTx to COVID-19 diagnosis 18,[21][22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][42][43][44][45][46][47][48][49][50][51][52][53] ; 77.4% of KTx recipients received their allograft more than 1 year before COVID-19 diagnosis (range 8 days-31 years). It is unclear whether this trend is simply a reflection of the patients with KTx or it disproportionally represents chronic transplant patients.…”

“…Laboratory evaluation was included in 33 of 37 studies. 18,19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44]46,[48][49][50][51][52][53][54] Most patients presented with lymphopenia appears to be self-limited and its clinical implications are not well described in the literature. 60 Regarding radiographic findings in KTx COVID-19-infected patients, 78.5% presented with bilateral ground-glass opacities in both chest plain radiograph and CT scan of the chest.…”

COVID-19 in Renal Transplant Patient Presenting With Active Typical Symptoms and Resolved Atypical Symptoms

“…The 2 patients who improved after tocilizumab treatment showed significant improvement in the lymphocyte count. 28 …”

Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

“…At the point of study completion, median LOH and LOI was 14 days (range 11-34) and 8 days (range [5][6][7][8][9][10][11] in patients receiving tocilizumab, which was speci ed in 15 studies 10,[20][21][22][23]28,29,31,32,35,36,[38][39][40][41] and 8 studies 10,23,27,29,32,33,36,42 , separately. Moreover, the median duration of mechanical ventilation was 7 days (range 5-10) after treatment of tocilizumab which was documented in 9 articles 10,11,[21][22][23]27,28,40,41 ( Table 2).…”