Should cyclosporine be useful in renal transplant recipients affected by SARS‐CoV‐2?

Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID‐19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect...

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Bibliographic Details
Published in:American Journal of Transplantation 2020-11, Vol.20 (11), p.3173-3181
Main Authors: Rodriguez‐Cubillo, Beatriz, Higuera, Maria Angeles Moreno, Lucena, Rafael, Franci, Elena V., Hurtado, Maria, Romero, Natividad C., Moreno, Antolina R., Valencia, Daniela, Velo, Mercedes, Fornie, Iñigo S., Sanchez‐Fructuoso, Ana I.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antiretroviral drugs
Antiviral agents
Antiviral drugs
Brief Communication
Brief Communications
Calcineurin
Calcineurin inhibitors
clinical research/practice
Comorbidity
Coronaviridae
Coronaviruses
COVID-19
COVID-19 - epidemiology
Cyclosporine - therapeutic use
Cyclosporins
Female
Graft rejection
Graft Rejection - prevention & control
health services and outcomes research
Humans
Hydroxychloroquine
Immunomodulation
immunosuppressant
Immunosuppression
Immunosuppression Therapy - methods
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Incidence
kidney disease: infectious
Kidney diseases
Kidney Transplantation
kidney transplantation / nephrology
Kidney transplants
Male
Mechanical ventilation
Middle Aged
Mycophenolic acid
Pandemics
Rapamycin
Renal function
Renal Insufficiency - epidemiology
Renal Insufficiency - surgery
Retrospective Studies
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Spain - epidemiology
Tacrolimus
TOR protein
Transplant Recipients
Ventilation
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Summary:Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID‐19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID‐19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine‐based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID‐19. Immunosuppression reduction alone, compared to immunosuppression reduction and maintenance of or conversion to low‐dose cyclosporine, was associated with less aggressive COVID‐19 disease in kidney transplant recipients.
ISSN:1600-6135
1600-6143
1600-6143
DOI:10.1111/ajt.16141