Yıl: 2022 Cilt: 47 Sayı: 4 Sayfa Aralığı: 1746 - 1752 Metin Dili: İngilizce DOI: 10.17826/cumj.1102779 İndeks Tarihi: 09-01-2023

Clinical follow up of renal transplant recipients with COVID-19: a case series

Öz:
COVID-19 has been recognized to become a worldwide health concern at an alarming rate over time and to be more progressive and fatal in specific risk populations. This study aims to determine the clinical features of COVID-19 in kidney transplant recipients (KTRxs) and contribute to the regulation of these patients’ immunosuppressive treatments and COVID-19 treatment protocols. The trial comprised eleven KTRxs with COVID-19. Immunosuppressive treatments such as antimetabolite cessation, calcineurin inhibitor dosage adjustments based on blood levels, and low-dose corticosteroids were all controlled. All patients received antiviral medication and low-molecular-weight-heparin (LMWH) as part of initial treatment. The steroid dose was then raised, and anti-cytokine therapies were provided in the setting of clinical worsening. The mean age of the patients was 50.3±11.2 years and 8 (73%) of them were male. The average time since transplantion was 6.82±3.34 years. Due to COVID-19 progression, the steroid dosage was raised in eight patients, anakinra and tocilizumab was added in five and one of the patients respectively. In five (%45) patients, the need for critical care arose and plasmapheresis was used in three of them. At the end of the follow-up, nine of our patients had made a complete recovery, whereas two (18.2%) had perished. Consistent with the literature, the data in presented study may also support the severe and fatal course of COVID-19 in KTRxs. It may be proposed that KTRxs with COVID-19 should be admitted to the hospital and constantly monitored, and certain effective management techniques should be initiated early depending on clinical circumstances.
Anahtar Kelime: COVID-19 ICU immunosuppression mortality kidney transplant recipients

COVID-19'lu böbrek nakli alıcılarının klinik takibi: bir vaka serisi

Öz:
COVID-19'un zaman içinde endişe verici oranda küresel bir sağlık sorunu haline geldiği ve belirli risk gruplarında daha ilerleyici ve ölümcül olduğu gözlenmiştir. Bu çalışma, böbrek nakli (RTx) alıcılarında COVID-19'un klinik özelliklerini belirlemeyi ve bu hastaların immünosupresif tedavileri ile COVID-19 tedavi protokollerinin düzenlenmesine katkıda bulunmayı amaçlamaktadır. Çalışmamıza, COVID-19'lu 11 RTx hastası dahil edildi. İmmünosupresif ilaçlar yattığı sürece “antimetabolitlerin kesilmesi, kalsinörin inhibitörerinin kan seviyelerine göre doz ayarlamaları ve kortikosteroidlerin dozunun azaltılması” şeklinde düzenlenerek uygulandı. Hastaneye yatış sonrası ilk basamakta antiviral ilaçlar ve düşük moleküler ağırlıklı heparin verildi. Steroid dozu daha sonra yükseltildi ve klinik kötüleşme durumunda anti-sitokin tedavileri sağlandı. Hastalarımızın yaş ortalaması 50,3±11,2 iken, 8'i (%73) erkekti. Transplantasyondan başvuru zamanına kadar geçen ortalama süre 6,82±3,34 yıldı. Takip sürecimizde COVID-19 progresyonu nedeniyle 8 hastada steroid dozu artırıldı, 5 hastada anakinra ve 1 hastada ise tocilizumab tedaviye eklendi. 5 hastada (%45) yoğun bakım ihtiyacı ortaya çıktı ve bunlardan 3’ne plazmaferez uygulandı. Takip sonunda 9 hastamız tamamen iyileşirken, 2 hastamız (%18,2) öldü. Böbrek nakil alıcılarında COVID-19’un ağır ve ölümcül seyrettiğini literatürle uyumlu şekilde bizim çalışmamızdaki veriler de desteklemektedir. Bu nedenle COVID-19'lu böbrek nakil alıcılarının hastaneye yatırılarak yakından izlenmesi ve klinik koşullara bağlı olarak etkili yönetim tekniklerinin erkenden başlatılması önerilebilir.
Anahtar Kelime: COVID-19 YBÜ immunosuppresyon mortalite böbrek nakil alıcıları

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
  • 1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323:1239-42.
  • 2. World Heath Organization (WHO). Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel- coronavirus-2019.html Accessed March 21, 2022.
  • 3. Centers of Disease Control and Prevention. In term infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. Updated April 1, 2020. https://www.cdc.gov/coronavirus/2019- ncov/infection-control/control recommendations.html Accessed April 6, 2020.
  • 4. Guillen E, Pineiro GJ, Revuelta I, Rodriguez D, Bodro M, Moreno A et al. Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation? Am J Transplant. 2020;20:1875-8.
  • 5. Chiu MC. Suggested management of immunocompromized kidney patients suffering from SARS. Pediatr Nephrol. 2003;18:1204-5.
  • 6. Kumar D, Tellier R, Draker R, Levy G, Humar A. Severe Acute Respiratory Syndrome (SARS) in a liver transplant recipient and guidelines for donor SARS screening. Am J Transplant. 2003;3:977-8.
  • 7. AlGhamdi M, Mushtaq F, Awn N, Shalhoub S. MERS CoV infection in two renal transplant recipients: case report. Am J Transplant. 2015;15:1101-4.
  • 8. Bruchfeld A. The COVID-19 pandemic: consequences for nephrology. Nat Rev Nephrol. 2021;17:81-2.
  • 9. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L et al. Dexamethasone in hospitalized patients with Covid- 19. N Engl J Med. 2021;384:693-704.
  • 10. Rizk JG, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Forthal DN. Pharmaco-immunomodulatory therapy in COVID-19. Drugs. 2020;80:1267-92.
  • 11. Aomar-Millán IF, Salvatierra J, Torres-Parejo Ú, Faro- Miguez N, Callejas-Rubio JL, Ceballos-Torres Á et al. Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study. Intern Emerg Med. 2021;16:843-52.
  • 12. Kadiroglu A.K. COVID-19 ve yoğun bakım süreci. Dicle Med J. 2021;48:15-22.
  • 13. Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int. 2020;97:1083- 88.
  • 14. Demir E, Uyar M, Parmaksiz E, Sinangil A, Yelken B, Dirim AB et al. COVID-19 in kidney transplant recipients: a multicenter experience in Istanbul. Transpl Infect Dis. 2020;22:e13371.
  • 15. Nair V, Jandovitz N, Hirsch JS, Nair G, Abate M, Bhaskaran M et al. COVID-19 in kidney transplant recipients. Am J Transplant. 2020;20:1819-25.
  • 16. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497- 506.
  • 17. Zhang JJY, Lee KS, Ang LW, Leo YS, Young BE. Risk factors for severe disease and efficacy of treatment in patients infected with COVID-19: a systematic review, meta-analysis, and meta-regression analysis. Clin Infect Dis. 2020;71:2199-2206.
  • 18. Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M. COVID-19 infection in kidney transplant recipients. Kidney Int. 2020;97:1076-82.
  • 19. Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V et al. Covid-19 and kidney transplantation. N Engl J Med. 2020;382:2475-77.
  • 20. Montagud-Marrahi E, Cofan F, Torregrosa JV, Cucchiari D, Ventura-Aguiar P, Revuelta I et al. Preliminary data on outcomes of SARS-CoV-2 infection in a Spanish single center cohort of kidney recipients. Am J Transplant. 2020;20:2958-59.
  • 21. Chen TY, Farghaly S, Cham S, Tatem LL, Sin JH, Rauda R et al. COVID-19 pneumonia in kidney transplant recipients: focus on immunosuppression management. Transpl Infect Dis. 2020;22:e13378.
  • 22. Azzi Y, Parides M, Alani O, Loarte-Campos P, Bartash R, Forest S et al. COVID-19 infection in kidney transplant recipients at the epicenter of pandemics. Kidney Int. 2020; 98:1559-67.
  • 23. Columbia University Kidney Transplant Program. Early description of coronavirus 2019 disease in kidney transplant recipients in New York. J Am Soc Nephrol. 2020;31:1150-56.
  • 24. Fisher AM, Schlauch D, Mulloy M, Dao A, Reyad AI, Correll M et al. Outcomes of COVID-19 in hospitalized solid organ transplant recipients compared to a matched cohort of non-transplant patients at a national healthcare system in the United States. Clin Transplant. 2021;35:e14216.
APA Güzel E, baydar o, Saygideger Y, Hanta İ, Paydas S, kaya b, TASOVA Y (2022). Clinical follow up of renal transplant recipients with COVID-19: a case series. , 1746 - 1752. 10.17826/cumj.1102779
Chicago Güzel Efraim,baydar oya,Saygideger Yasemin,Hanta İsmail,Paydas Saime,kaya bulent,TASOVA YESIM Clinical follow up of renal transplant recipients with COVID-19: a case series. (2022): 1746 - 1752. 10.17826/cumj.1102779
MLA Güzel Efraim,baydar oya,Saygideger Yasemin,Hanta İsmail,Paydas Saime,kaya bulent,TASOVA YESIM Clinical follow up of renal transplant recipients with COVID-19: a case series. , 2022, ss.1746 - 1752. 10.17826/cumj.1102779
AMA Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y Clinical follow up of renal transplant recipients with COVID-19: a case series. . 2022; 1746 - 1752. 10.17826/cumj.1102779
Vancouver Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y Clinical follow up of renal transplant recipients with COVID-19: a case series. . 2022; 1746 - 1752. 10.17826/cumj.1102779
IEEE Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y "Clinical follow up of renal transplant recipients with COVID-19: a case series." , ss.1746 - 1752, 2022. 10.17826/cumj.1102779
ISNAD Güzel, Efraim vd. "Clinical follow up of renal transplant recipients with COVID-19: a case series". (2022), 1746-1752. https://doi.org/10.17826/cumj.1102779
APA Güzel E, baydar o, Saygideger Y, Hanta İ, Paydas S, kaya b, TASOVA Y (2022). Clinical follow up of renal transplant recipients with COVID-19: a case series. Cukurova Medical Journal, 47(4), 1746 - 1752. 10.17826/cumj.1102779
Chicago Güzel Efraim,baydar oya,Saygideger Yasemin,Hanta İsmail,Paydas Saime,kaya bulent,TASOVA YESIM Clinical follow up of renal transplant recipients with COVID-19: a case series. Cukurova Medical Journal 47, no.4 (2022): 1746 - 1752. 10.17826/cumj.1102779
MLA Güzel Efraim,baydar oya,Saygideger Yasemin,Hanta İsmail,Paydas Saime,kaya bulent,TASOVA YESIM Clinical follow up of renal transplant recipients with COVID-19: a case series. Cukurova Medical Journal, vol.47, no.4, 2022, ss.1746 - 1752. 10.17826/cumj.1102779
AMA Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y Clinical follow up of renal transplant recipients with COVID-19: a case series. Cukurova Medical Journal. 2022; 47(4): 1746 - 1752. 10.17826/cumj.1102779
Vancouver Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y Clinical follow up of renal transplant recipients with COVID-19: a case series. Cukurova Medical Journal. 2022; 47(4): 1746 - 1752. 10.17826/cumj.1102779
IEEE Güzel E,baydar o,Saygideger Y,Hanta İ,Paydas S,kaya b,TASOVA Y "Clinical follow up of renal transplant recipients with COVID-19: a case series." Cukurova Medical Journal, 47, ss.1746 - 1752, 2022. 10.17826/cumj.1102779
ISNAD Güzel, Efraim vd. "Clinical follow up of renal transplant recipients with COVID-19: a case series". Cukurova Medical Journal 47/4 (2022), 1746-1752. https://doi.org/10.17826/cumj.1102779