Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología
Introduction: 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 targe...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/208419 |
| Acceso en línea: | https://hdl.handle.net/2445/208419 |
| Access Level: | acceso abierto |
| Palabra clave: | SARS-CoV-2 Trasplantament renal Kidney transplantation |
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Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de NefrologíaLópez Oliva, María O.Pérez Flores, IsabelMolina, MaríaAladrén, M. JoséTrujillo, HernandoRedondo Pachón, DoloresLópez, VerónicaFacundo, CarmeVillanego, FlorentinoRodríguez, MarisaRuiz, M. CarmenAntón, PaulaRivas Oural, AlbaCabello, SheilaPortolés, JoséVara, Lourdes de laTabernero, GuadalupeValero, RosalíaGaleano, CristinaMoral, EsperanzaVentura, AnaCoca, ArmandoMuñoz Pérez, Miguel ÁngelHernández Gallego, RománShabaka, AmirLedesma, GabrielBouarich, HananeRodríguez, M. ÁngelesPérez Tamajón, LourdesCruzado, LeónidasSánchez, J. EmilioJiménez, CarlosSARS-CoV-2Trasplantament renalSARS-CoV-2Kidney transplantationIntroduction: 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.Objectives: 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.Material and methods: 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.Results: 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.Conclusions: 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.Elsevier BV2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/208419Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.nefro.2022.03.008Nefrología, 2023, vol. 43, num. 4, p. 442-451https://doi.org/10.1016/j.nefro.2022.03.008cc by-nc-nd (c) López Oliva, María O. et al., 2023http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2084192026-05-27T06:46:51Z |
| dc.title.none.fl_str_mv |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| title |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| spellingShingle |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología López Oliva, María O. SARS-CoV-2 Trasplantament renal SARS-CoV-2 Kidney transplantation |
| title_short |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| title_full |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| title_fullStr |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| title_full_unstemmed |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| title_sort |
Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19. Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Española de Nefrología |
| dc.creator.none.fl_str_mv |
López Oliva, María O. Pérez Flores, Isabel Molina, María Aladrén, M. José Trujillo, Hernando Redondo Pachón, Dolores López, Verónica Facundo, Carme Villanego, Florentino Rodríguez, Marisa Ruiz, M. Carmen Antón, Paula Rivas Oural, Alba Cabello, Sheila Portolés, José Vara, Lourdes de la Tabernero, Guadalupe Valero, Rosalía Galeano, Cristina Moral, Esperanza Ventura, Ana Coca, Armando Muñoz Pérez, Miguel Ángel Hernández Gallego, Román Shabaka, Amir Ledesma, Gabriel Bouarich, Hanane Rodríguez, M. Ángeles Pérez Tamajón, Lourdes Cruzado, Leónidas Sánchez, J. Emilio Jiménez, Carlos |
| author |
López Oliva, María O. |
| author_facet |
López Oliva, María O. Pérez Flores, Isabel Molina, María Aladrén, M. José Trujillo, Hernando Redondo Pachón, Dolores López, Verónica Facundo, Carme Villanego, Florentino Rodríguez, Marisa Ruiz, M. Carmen Antón, Paula Rivas Oural, Alba Cabello, Sheila Portolés, José Vara, Lourdes de la Tabernero, Guadalupe Valero, Rosalía Galeano, Cristina Moral, Esperanza Ventura, Ana Coca, Armando Muñoz Pérez, Miguel Ángel Hernández Gallego, Román Shabaka, Amir Ledesma, Gabriel Bouarich, Hanane Rodríguez, M. Ángeles Pérez Tamajón, Lourdes Cruzado, Leónidas Sánchez, J. Emilio Jiménez, Carlos |
| author_role |
author |
| author2 |
Pérez Flores, Isabel Molina, María Aladrén, M. José Trujillo, Hernando Redondo Pachón, Dolores López, Verónica Facundo, Carme Villanego, Florentino Rodríguez, Marisa Ruiz, M. Carmen Antón, Paula Rivas Oural, Alba Cabello, Sheila Portolés, José Vara, Lourdes de la Tabernero, Guadalupe Valero, Rosalía Galeano, Cristina Moral, Esperanza Ventura, Ana Coca, Armando Muñoz Pérez, Miguel Ángel Hernández Gallego, Román Shabaka, Amir Ledesma, Gabriel Bouarich, Hanane Rodríguez, M. Ángeles Pérez Tamajón, Lourdes Cruzado, Leónidas Sánchez, J. Emilio Jiménez, Carlos |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
SARS-CoV-2 Trasplantament renal SARS-CoV-2 Kidney transplantation |
| topic |
SARS-CoV-2 Trasplantament renal SARS-CoV-2 Kidney transplantation |
| description |
Introduction: 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.Objectives: 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.Material and methods: 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.Results: 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.Conclusions: 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. |
| publishDate |
2023 |
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2023 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/208419 |
| url |
https://hdl.handle.net/2445/208419 |
| dc.language.none.fl_str_mv |
Inglés |
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Inglés |
| dc.relation.none.fl_str_mv |
Reproducció del document publicat a: https://doi.org/10.1016/j.nefro.2022.03.008 Nefrología, 2023, vol. 43, num. 4, p. 442-451 https://doi.org/10.1016/j.nefro.2022.03.008 |
| dc.rights.none.fl_str_mv |
cc by-nc-nd (c) López Oliva, María O. et al., 2023 http://creativecommons.org/licenses/by-nc-nd/3.0/es/ info:eu-repo/semantics/openAccess |
| rights_invalid_str_mv |
cc by-nc-nd (c) López Oliva, María O. et al., 2023 http://creativecommons.org/licenses/by-nc-nd/3.0/es/ |
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openAccess |
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application/pdf |
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Elsevier BV |
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Elsevier BV |
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Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) reponame:Dipòsit Digital de la UB instname:Universidad de Barcelona |
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Universidad de Barcelona |
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Dipòsit Digital de la UB |
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Dipòsit Digital de la UB |
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