Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone

Suryantoro, Satriyo Dwi; Thaha, Mochammad; Pranawa,; Santoso, Djoko; Mardiana, Nunuk; Widodo, Widodo; Aditiawardana,; Tjempakasari, Artaria; Ardhany, Ardityo Rahmat; Pramudya, Dana; Hertanto, Decsa Medika; Febriane, Evy; Meryana,; Ângela, Maria; Muliono, Ari Christy; Tanuwidjaja, Handoko; Setiawan, Philia; Sugiarto, David

doi:10.3855/jidc.14952

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…In the current study, tacrolimus was stopped on the deterioration of the chest condition and on mechanically ventilated patients spite of this, the three cases died after a few days. Our finding was not matched with Suryantoro and his colleagues, 2021 who decided to stop the immunosuppressive agents and followed administration of lopinavir/ritonavir, hydroxychloroquine, and dexamethasone which gives a good clinical effect on the patient's condition after being worsened and mechanically ventilated [16]. This could be attributed to their use of different antivirals and or their use of hydroxychloroquine in their protocol of management.…”

Section: Discussioncontrasting

confidence: 72%

Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Megahed

Mohamed²,

El-Said

et al. 2022

AJMAH

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Aims: We aimed to observe the effect of modification of the immunosuppressive regimen in response to the severity of COVID-19 infection on the outcome of renal disease patients and to study factors affecting their mortality. Methods and Materials: The study was conducted on 18 patients (13 males and 5 females) admitted to the King Salman Specialized hospital (KSSH), a COVID-19 isolation center, in Hail city in KSA; of them, 16 had kidney transplantation maintained on immunosuppression protocols, while 2 had immune-mediated nephritis maintained on immunosuppression. Locally agreed immunosuppressive protocol, the antivirals used as well as the used anticoagulant were followed without interference. Demographic data, associated comorbidities, baseline x-ray, routine laboratory data, and patients’ outcomes were recorded. Results: The ages of the studied patients ranged from 23 - 60 years. Nine patients were treated in the ward (group 1) and the other 9 patients needed admission to the ICU (group 2). Compared to group 1, group 2 patients had higher mortality, higher levels of TLC, CRP, and serum phosphorus as well as admission LDH and D-dimer. Furthermore, group 2 patients had lower serum albumin, and lower blood platelet and lymphocyte counts. All patients continued on corticosteroids and calcineurin inhibitors in case they had been maintained on them before the infection. Antiproliferative drugs (MMF or Azathioprine) were discontinued in all patients; 15 of them stopped it on the first admission day and 3 were reluctant to stop the drugs till a few days later when they were admitted to the ICU. Of the total observed patients 4 died; 3 of them were those who did not stop these drugs early in the course of the disease. Conclusions: Appropriately early discontinuation of antiproliferative drugs in renal immunosuppressed patients and the use of higher doses of systemic steroids were associated with better prognosis of COVID-19 infection patients and did not cause deterioration of kidney function.

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Section: Discussioncontrasting

confidence: 72%

Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Megahed

Mohamed²,

El-Said

et al. 2022

AJMAH

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Methylprednisolone/mycophenolate sodium/tacrolimus

2021

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Methylprednisolone/mycophenolate sodium/tacrolimus COVID-19 and its worsening: case reportA 70-year-old woman developed COVID-19 and its further worsening during immunosuppression therapy with methylprednisolone, mycophenolate sodium and tacrolimus.The woman, who had undergone kidney transplantation in 2017, admitted to the emergency ward with shortness of breath for 1 week. She reported productive cough, fever and frequent watery diarrhoea. She had nausea and decreased appetite. She had been receiving immunosuppression therapy for her transplantation with tacrolimus 1mg twice daily, mycophenolate sodium [mycophenolic sodium] 180mg twice daily and methylprednisolone 4mg once daily [routes not stated]. At the emergency room, she exhibited a positive COVID-19 result from a nasal swab utilising RT-PCR (reverse transcription polymerase chain reaction). At the time of the initial evaluation, her physical examination revealed a blood pressure of 147/78mm Hg, heart rate (HR) of 98 beats/min with a regular rhythm, a strong pulse, and normal amplitude; a respiratory rate (RR) of 22 breaths/min, an axillary temperature of 36.9°C and an oxygen saturation of 95% ambient air. Laboratory tests showed normal leucocyte of 4540 /µL, increased level of CRP 55.3 mg/L, ferritin 378.3 ng/mL, normal D-dimer level and normal kidney function test. There was moderate hyponatraemia and tacrolimus level was found to be 4.3 ng/mL. Chest radiography revealed pulmonary consolidation in the right perihillar and left paracardial field. It was concluded that, COVID-19 was related to immunosuppression therapy with methylprednisolone, mycophenolate sodium and tacrolimus [duration of treatments to reaction onset not stated].The woman was therefore treated with an off-label lopinavir/ritonavir at a fixed dose combination for 14 days, an off-label hydroxychloroquine for 5 days and an off-label dexamethasone 6mg for 10 days. Hyponatraemia was treated with unspecified treatment. Her shortness of breath worsened on the third day of the hospitalisation, with an elevated respiratory rate 28 breaths/min and a drop in peripheral capillary oxygen saturation to 92%. Laboratory results showed increased levels of CRP 88.8 mg/L, ferritin 462.50 ng/mL and tacrolimus 24 ng/mL. Also, arterial PO2 level dropped to 58mm Hg. Worsening of her overall condition was noted and it was determined to be related to the immunosuppression therapy. Therefore, on the third day the hospitalization, treatment with tacrolimus, methylprednisolone and mycophenolate sodium was discontinued, and she was intubated. She was initiated on an off-label IV heparin therapy 1500IU in 1h followed by 350 IU/h. On the eighth day of the hospitalisation, improvement in chest radiography and laboratory results was noted, and arterial pO2 level increased to 73mm Hg. Her sputum culture was found to be positive for Stenotrophomonas maltophilia on the thirteenth day of the hospitalisation. Hence, moxifloxacin was initiated. On the sixteenth day of the hospitalisation, she was extubated and oropharyngeal/...

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Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone

Cited by 2 publications

References 19 publications

Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Methylprednisolone/mycophenolate sodium/tacrolimus

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