Author: Pérezâ€Sáez, MarÃa J.; Blasco, Miquel; Redondoâ€Pachón, Dolores; Venturaâ€Aguiar, Pedro; Badaâ€Bosch, Teresa; Pérezâ€Flores, Isabel; Melilli, Edoardo; Sánchezâ€Cámara, Luis A.; Lópezâ€Oliva, MarÃa O.; Canal, Cristina; Shabaka, Amir; Garraâ€Moncau, Núria; MartÃnâ€Moreno, Paloma L.; López, Verónica; Hernándezâ€Gallego, Román; Siverio, Orlando; Galeano, Cristina; EspÃâ€Reig, Jordi; Cabezas, Carlos J.; Rodrigo, MarÃa T.; Llinà sâ€Mallol, Laura; Fernándezâ€Reyes, MarÃa J.; Cruzadoâ€Vega, Leónidas; Pérezâ€Tamajón, Lourdes; Santanaâ€Estupiñán, Raquel; Ruizâ€Fuentes, MarÃa C; Tabernero, Guadalupe; Zárraga, SofÃa; Ruiz, Juan C; Gutiérrezâ€Dalmau, Alex; Mazuecos, Auxiliadora; Sánchezâ€Ãlvarez, Emilio; Crespo, Marta; Pascual, Julio
Title: Use of tocilizumab in kidney transplant recipients with COVIDâ€19 Cord-id: tn03dgsc Document date: 2020_8_4
ID: tn03dgsc
Snippet: Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukinâ€6 (ILâ€6) release. The ILâ€6â€receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVIDâ€19) . In this pandemic, kidney transplant (KT) recipients are a highâ€risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVIDâ€1
Document: Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukinâ€6 (ILâ€6) release. The ILâ€6â€receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVIDâ€19) . In this pandemic, kidney transplant (KT) recipients are a highâ€risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVIDâ€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). ILâ€6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and Dâ€dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, Câ€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 1.004â€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 COVIDâ€19 but randomized trials are needed.
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