Barbara Infante, Silvia Mercuri, Dario Troise, Giuseppe Castellano, Stallone Giovanni
Nephrology Dialysis and Transplantation Unit, University of Foggia, Foggia, Italy.
Unit of Nephrology, Dialysis and Renal Transplantation-Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Front Med (Lausanne). 2021 Nov 25;8:732792. doi: 10.3389/fmed.2021.732792. eCollection 2021.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated in January 2020 and, on March, the WHO declared the status of a pandemic. It causes a cytokine release syndrome, called "cytokine storm," characterized by systemic inflammation involving elevated levels of cytokines and hyperactivation of immune cell; this profound alteration in the immune system led to an overshooting inflammatory response contributing to morbidity and mortality. Solid organ transplant recipients are at particularly higher risk of developing critical coronavirus disease 2019 (COVID-19) due to chronic immunosuppression; in fact, establishing the balance between infection and rejection in any transplant recipient is the principal aim when prescribing immunosuppression. Tocilizumab, a humanized monoclonal antibody against interleukin-6 (IL-6) receptor widely adopted in adult rheumatoid arthritis, is used as rescue therapy for chronic antibody-mediated rejection in kidney transplantation. Data about the use of tocilizumab for treating acute kidney graft dysfunction in a setting of kidney-transplanted patients affected by COVID-19 are lacking. In this case study, we discuss the case of kidney transplant recipient with proven SARS-CoV-2 infection that develops acute graft dysfunction and the management of immunosuppression with concomitant tocilizumab administration.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）于2020年1月被分离出来，3月，世界卫生组织宣布其为大流行病状态。它会引发一种细胞因子释放综合征，称为“细胞因子风暴”，其特征是全身性炎症，表现为细胞因子水平升高和免疫细胞过度激活；免疫系统的这种深刻改变导致炎症反应过度，从而导致发病和死亡。由于慢性免疫抑制，实体器官移植受者患重症冠状病毒病2019（COVID-19）的风险尤其高；事实上，在任何移植受者中确定感染与排斥之间的平衡是开具免疫抑制药物时的主要目标。托珠单抗是一种广泛用于成人类风湿性关节炎的抗白细胞介素-6（IL-6）受体的人源化单克隆抗体，被用作肾移植中慢性抗体介导排斥反应的挽救治疗药物。目前缺乏关于托珠单抗用于治疗受COVID-19影响的肾移植患者急性肾移植功能障碍的数据。在本病例研究中，我们讨论了一名确诊感染SARS-CoV-2的肾移植受者出现急性移植功能障碍的病例以及同时给予托珠单抗时免疫抑制的管理。
