SARS‐CoV‐2 infection in kidney transplant recipients: experience of the italian marche region

Maritati, Federica; Cerutti, Elisabetta; Zuccatosta, Lina; Fiorentini, Alessandro; Finale, Carolina; Ficosecco, Marta; Cristiano, Fabrizio; Capestro, Alessandro; Balestra, Emilio; Taruscia, Domenica; Vivarelli, Marco; Donati, Abele; Perna, Gian Piero; Giacometti, Andrea; Tavio, Marcello; Onesta, Maicol; Di Sante, Laura; Ranghino, Andrea

BACKGROUND: Infection related to Coronavirus‐19 (CoV‐2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May, 10 2020 it caused more than 280.000 deaths all over the world. Preliminary data reported a high prevalence of CoV‐2 infection and mortality due to severe acute respiratory syndrome‐related to CoV‐2 (SARS‐CoV‐2) in kidney transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS‐CoV‐2 affected KTRs remain unclear. METHODS: In this report we describe the clinical data, the treatments and the outcomes of 5 KTRs with SARS‐CoV‐2 admitted to our hospital in Ancona, Marche region, Italy, from March, 17 to present. Due to the severity of SARS‐CoV‐2, immunosuppression with calcineurin inhibitors, antimetabolites and mTOR‐inhibitors were stopped at the admission. All KTRs were treated with low‐dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose. RESULTS: Overall, the incidence of SARS‐CoV‐2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present 2 patients died, 2 patients were discharged and one is still inpatient in ICU. CONCLUSIONS: The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin‐6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS‐CoV‐2 affected KTRs a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase of the laboratory values such as D‐Dimer.