Tags

Type your tag names separated by a space and hit enter

Use of tocilizumab in kidney transplant recipients with COVID-19.
Am J Transplant. 2020 Jul 12 [Online ahead of print]AJ

Abstract

Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.

Authors+Show Affiliations

Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain.Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain.Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain.Department of Nephrology, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.Department of Nephrology, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain.Department of Nephrology, Research Support Unit, Fundació Puigvert, Barcelona, Spain.Department of Nephrology, Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain.Department of Nephrology, Fundació Althaia, Manresa, Barcelona, Spain.Department of Nephrology, Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain.Department of Nephrology, Hospital Regional Universitario, Universidad de Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain.Department of Nephrology, Hospital Universitario, Badajoz, Spain.Department of Nephrology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain.Department of Nephrology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.Department of Nephrology, Complejo Hospitalario de Toledo, Toledo, Spain.Department of Nephrology, Hospital Universitario Donostia, Donostia, Spain.Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.Department of Nephrology, Complejo Asistencial Segovia, Segovia, Spain.Department of Nephrology, Hospital General Universitario, Elche, Alicante, Spain.Department of Nephrology, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain.Department of Nephrology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain.Department of Nephrology, Hospital Universitario, IBSAL, Salamanca, Spain.Department of Nephrology, Hospital de Cruces, Bilbao, Spain.Department of Nephrology, Hospital de Valdecilla, University of Cantabria, IDIAL, Santander, Spain.Department of Nephrology, Hospital Universitario Miguel Servet, Zaragoza, Spain.Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain.Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain.Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32654422

Citation

Pérez-Sáez, María J., et al. "Use of Tocilizumab in Kidney Transplant Recipients With COVID-19." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2020.
Pérez-Sáez MJ, Blasco M, Redondo-Pachón D, et al. Use of tocilizumab in kidney transplant recipients with COVID-19. Am J Transplant. 2020.
Pérez-Sáez, M. J., Blasco, M., Redondo-Pachón, D., Ventura-Aguiar, P., Bada-Bosch, T., Pérez-Flores, I., Melilli, E., Sánchez-Cámara, L. A., López-Oliva, M. O., Canal, C., Shabaka, A., Garra-Moncau, N., Martín-Moreno, P. L., López, V., Hernández-Gallego, R., Siverio, O., Galeano, C., Espí-Reig, J., Cabezas, C. J., ... Pascual, J. (2020). Use of tocilizumab in kidney transplant recipients with COVID-19. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. https://doi.org/10.1111/ajt.16192
Pérez-Sáez MJ, et al. Use of Tocilizumab in Kidney Transplant Recipients With COVID-19. Am J Transplant. 2020 Jul 12; PubMed PMID: 32654422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of tocilizumab in kidney transplant recipients with COVID-19. AU - Pérez-Sáez,María J, AU - Blasco,Miquel, AU - Redondo-Pachón,Dolores, AU - Ventura-Aguiar,Pedro, AU - Bada-Bosch,Teresa, AU - Pérez-Flores,Isabel, AU - Melilli,Edoardo, AU - Sánchez-Cámara,Luis A, AU - López-Oliva,María O, AU - Canal,Cristina, AU - Shabaka,Amir, AU - Garra-Moncau,Núria, AU - Martín-Moreno,Paloma L, AU - López,Verónica, AU - Hernández-Gallego,Román, AU - Siverio,Orlando, AU - Galeano,Cristina, AU - Espí-Reig,Jordi, AU - Cabezas,Carlos J, AU - Rodrigo,María T, AU - Llinàs-Mallol,Laura, AU - Fernández-Reyes,María J, AU - Cruzado-Vega,Leónidas, AU - Pérez-Tamajón,Lourdes, AU - Santana-Estupiñán,Raquel, AU - Ruiz-Fuentes,María C, AU - Tabernero,Guadalupe, AU - Zárraga,Sofía, AU - Ruiz,Juan C, AU - Gutiérrez-Dalmau,Alex, AU - Mazuecos,Auxiliadora, AU - Sánchez-Álvarez,Emilio, AU - Crespo,Marta, AU - Pascual,Julio, AU - ,, Y1 - 2020/07/12/ PY - 2020/05/26/received PY - 2020/06/12/revised PY - 2020/06/28/accepted PY - 2020/7/13/pubmed PY - 2020/7/13/medline PY - 2020/7/13/entrez KW - clinical research/practice KW - infection and infectious agents - viral KW - kidney transplantation/nephrology KW - patient survival JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am. J. Transplant. N2 - Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed. SN - 1600-6143 UR - https://www.unboundmedicine.com/medline/citation/32654422/Use_of_tocilizumab_in_kidney_transplant_recipients_with_COVID-19 L2 - https://doi.org/10.1111/ajt.16192 DB - PRIME DP - Unbound Medicine ER -