Use and safety of remdesivir in kidney transplant recipients with COVID-19

Buxeda, Anna; Arias-Cabrales, Carlos; Pérez-Sáez, María José; Cacho, Judit; Pelegrin, Sheila Cabello; Melilli, Edoardo; Aladrén, María José; Galeano, Cristina; Lorenzo, Inmaculada; Mazuecos, Auxiliadora; Saura, Isabel María; Franco, Antonio; Ruiz-Fuentes, María del Carmen; Sánchez-Cámara, Luis Alberto; Siverio, Orlando; Martin, María Luisa; González-García, Elena; López, Verónica; Martin-Moreno, Paloma Leticia; Moina, Iñigo; Berrio, Esperanza Moral; Moreso, Francesc; Portolés, José María; Santana-Estupiñán, Raquel; Zárraga, Sofía; Canal, Cristina; Sánchez-Álvarez, Emilio; Pascual, Julio; Crespo, Marta

INTRODUCTION: Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney injury (AKI) have been reported. There is little available data on the use and safety of remdesivir in kidney transplant (KT) recipients. METHODS: We present a multicenter cohort study of 51 KT recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed. RESULTS: Mean age at diagnosis was 60 years, with a median time since KT of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 non-invasive). Mortality was 18.9%, markedly higher if ≥65 years-old (45% vs. 3.2% in younger patients). AKI was present in 27.7% of patients, but in 50% of cases it was diagnosed before treatment. Remdesivir did not require discontinuation because of adverse events in any case. We did not find significant hepatoxicity or systemic symptoms resultant from the drug. CONCLUSIONS: In our cohort of KT recipients, remdesivir was well tolerated and safe in terms of renal and hepatic toxicity, but randomized trials are needed to assess its efficacy.