López-Oliva María O, Pérez-Flores Isabel, Molina María, José Aladrén Mª, Trujillo Hernando, Redondo-Pachón Dolores, López Verónica, Facundo Carme, Villanego Florentino, Rodríguez Marisa, Carmen Ruiz Mª, Antón Paula, Rivas-Oural Alba, Cabello Sheila, Portolés José, de la Vara Lourdes, Tabernero Guadalupe, Valero Rosalía, Galeano Cristina, Moral Esperanza, Ventura Ana, Coca Armando, Muñoz Miguel Ángel, Hernández-Gallego Román, Shabaka Amir, Ledesma Gabriel, Martínez Patricia, Ángeles Rodríguez Mª, Tamajón Lourdes Pérez, Cruzado Leónidas, Emilio Sánchez J, Jiménez Carlos
Servicio de Nefrología, Hospital U. La Paz, Madrid, Spain.
Servicio de Nefrología, Hospital U. Clínico San Carlos, Madrid, Spain.
Nefrologia. 2022 Apr 30. doi: 10.1016/j.nefro.2022.03.008.
SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated.
Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis.
Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis.
615 renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years.The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased.Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7±0.8, 2.1±1.2 and 1.8±1 mg/dl respectively (p<0.001).56.9% of the patients (N=350) were monitored for anti-HLA antibodies. 94% (N=329) had no anti-HLA changes, while 6% (N=21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N=9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant.
The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染对肾移植患者产生了重大影响，在疫情的最初几个月死亡率很高。在缺乏针对性抗病毒治疗的情况下，有意减少免疫抑制治疗被认为是管理该感染的基石之一。这已根据患者的临床情况进行了调整，但其对肾功能或中期抗人白细胞抗原（HLA）抗体的影响尚未评估。
评估SARS-CoV-2感染期间进行的免疫抑制治疗管理，以及新冠病毒病（COVID-19）诊断6个月后肾移植患者的肾功能和抗HLA抗体。
对2020年2月1日至2020年12月31日期间感染COVID-19的肾移植受者进行回顾性、全国多中心研究（30个中心）。从病历中收集临床变量并纳入匿名数据库。使用SPSS统计软件进行数据分析。
纳入615例感染COVID-19的肾移植受者（62.6%为男性），平均年龄57.5岁。COVID-19之前主要的免疫抑制治疗是泼尼松、他克莫司和霉酚酸三联疗法（54.6%），其次是雷帕霉素靶蛋白（m-TOR）抑制剂方案（18.6%）。感染诊断后，73.8%的患者停用了霉酚酸，41.4%的患者停用了m-TOR抑制剂，10.5%的患者停用了他克莫司，10%的患者停用了环孢素A。相应地，26.9%的患者接受了地塞米松治疗，50.9%的患者开始使用或增加了基线泼尼松剂量。COVID-19诊断前、诊断时和6个月时的平均肌酐分别为：1.7±0.8、2.1±1.2和1.8±1mg/dl（p<0.001）。56.9%的患者（N=350）接受了抗HLA抗体监测。94%（N=329）的患者抗HLA无变化，而6%（N=21）的患者抗HLA抗体呈阳性。在COVID-19后出现供体特异性抗体的患者中（N=9），7例患者（3.1%）停用了一种免疫抑制剂（5例停用霉酚酸，2例停用他克莫司），1例患者停用了两种免疫抑制剂（3.4%），1例患者免疫抑制无变化（1.1%），这些差异无统计学意义。
COVID-19诊断后的免疫抑制治疗管理主要基于停用霉酚酸，钙调神经磷酸酶抑制剂的减少或停用非常少。这种免疫抑制管理在诊断6个月后对肾功能或抗HLA抗体的变化没有影响。
