Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal

López, Verónica; Vazquez, Teresa; Alonso-Titos, Juana; Cabello, Mercedes; Alonso, Ángel; Beneyto, Isabel; Crespo, Marta; Díaz‐Corte, Carmen; Franco, Antônio; González-Roncero, F.M.; Gutiérrez, Elena; Guirado, Luís; Jiménez, Carlos; Jironda, Cristina; Lauzurica, Ricardo; Llorente, Santiago; Mazuecos, Auxiliadora; Paúl, Javier; Rodríguez‐Benot, Alberto; Ruiz, Juan Carlos; Sánchez‐Fructuoso, Ana; Sola, E.; Torregrosa, Vicente; Zárraga, Sofía; Hernández, Domingo

doi:10.1016/j.nefro.2020.03.002

Cited by 55 publications

(37 citation statements)

References 17 publications

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“…There is also the fear that complete withdrawal of immunosuppressive drugs may exacerbate the hyperinflammatory response that may occur in the late stages of COVID-19. After reading the expert opinions published by single centres (Table 1) and societies (French [21], Spanish [22], British [23], American [24]), and after extensive discussions between its members, the DESCARTES WG formulated suggestions for COVID-19-infected KTRs who are beyond 3-6 months after kidney transplantation ( Table 2).…”

Section: Introductionmentioning

confidence: 99%

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

Maggiore

Abramowicz

Crespo

et al. 2020

Nephrology Dialysis Transplantation

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110

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Section: Introductionmentioning

confidence: 99%

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

Maggiore

Abramowicz

Crespo

et al. 2020

Nephrology Dialysis Transplantation

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110

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“…[1][2][3][4][5][6][7] Although uremia and kidney transplantation are not considered a risk factor in COVID-19, SARS-CoV-2 often causes a moderate or severe infection in kidney transplant recipients. [1][2][3][4][5][6][7] Lymphopenia, increased inflammatory markers, prothrombin time, and creatine phosphokinase are prognostic factors for COVID-19. 8,9 Acute kidney injury is also associated with increased morbidity and mortality in COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Diagnosis is usually based on fever, respiratory symptoms, contact history, typical chest radiology, and biochemical findings. [6][7][8][9] Positive reverse transcription-polymerase chain reaction (RT-PCR) results…”

Section: Introductionmentioning

confidence: 99%

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COVID‐19 in kidney transplant recipients: A multicenter experience in Istanbul

Demir

Uyar

Parmaksız

et al. 2020

Transplant Infectious Dis

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Introduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.

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“…Los principales factores de riesgo para enfermedad severa descritos son: edad ≥ 65 años, hipertensión, diabetes mellitus, enfermedad coronaria, enfermedad pulmonar obstructiva y neoplasias. [1][2][3][4] Dentro de los pocos reportes locales hasta ahora publicados, Bello-Chavolla 5 y colegas describen en un registro de 15,529 casos confirmados un predominio del sexo masculino (58%) acorde a otros reportes, sin embargo, con una presentación a edad más joven (46.5 ± 15.1), con predominio de comorbilidades como diabetes mellitus, obesidad e hipertensión, en el que sólo una tercera parte fueron casos leves y menos de 5% requirió apoyo de cuidados intensivos, con una mortalidad general alrededor de 9%, un poco más alta comparada a la encontrada en otros reportes, tal como se describe en la Tabla 1.…”

Section: Introductionunclassified

COVID-19: Manifestaciones clínicas y diagnóstico

Parra-Avila¹

2020

Revista Mexicana De Trasplantes

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In general population, the clinical picture of SARS-CoV-2 infection is characterized by symptoms such as fever, cough and fatigue. Incubation period ranges from 5 or 6 days to 14 days, generally they are mild cases with outpatient management and only 30% will be admitted in hospital. Main risk factors for severe disease are: age ≥ 65 years, obesity, arterial hypertension, diabetes mellitus, coronary heart disease, obstructive pulmonary disease, and malignancies. General mortality is around 5% but may be higher in critically ill patients. In transplant recipients, who are under immunosuppression, it is expected that clinical picture, laboratory and imaging findings could be different compared with general population, as has been observed with other kind of infections. However, in several published reports, there are no differences with non-transplanted population. Although clinical picture may be mild, frequency of complications is more common in transplanted population. Mortality is around 20%, higher than non-transplanted population. Molecular diagnosis with RT-PCR is defined as the gold standard, however its sensitivity is below 80%. Undoubtedly, the epidemiological circumstances, clinical suspicion, RT-PCR report and imaging tests are complementary to establishing a correct diagnosis.

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Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal

Cited by 55 publications

References 17 publications

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

COVID‐19 in kidney transplant recipients: A multicenter experience in Istanbul

COVID-19: Manifestaciones clínicas y diagnóstico

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