Manejo de la inmunosupresión en pacientes trasplantados de riñón con COVID19 : Estudio multicéntrico nacional derivado del registro COVID de la Sociedad Espa˜nola deNefrología
López-Oliva, María Ovidia (Hospital Universitario La Paz (Madrid))
Pérez-Flores, Isabel (Hospital Universitario Clínico San Carlos (Madrid))
Molina Molina, Maria (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
José Aladrén, María (Hospital Universitario Miguel Servet (Saragossa))
Trujillo, Hernando (Hospital 12 de Octubre (Madrid))
Redondo-Pachón, Dolores (Hospital del Mar (Barcelona, Catalunya))
López Jiménez, Verónica (Hospital Regional Universitario Carlos Haya (Málaga))
Facundo, Carme (Institut d'Investigació Biomèdica Sant Pau)
Villanego, Florentino (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Rodríguez, Marisa (Hospital General Universitario Gregorio Marañón)
Ruiz, Maria Carmen (Hospital Universitario Virgen de las Nieves (Granada))
Antón, Paula (Hospital Universitari de Bellvitge)
Rivas-Oural, Alba (Hospital Universitario Central de Asturias)
Cabello, Sheila (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Portolés, José (Complejo Hospitalario Universitario de Albacete)
de la Vara, Lourdes (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Tabernero, Guadalupe (Hospital Clínico Universitario (Salamanca))
Valero, Rosalía (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Galeano Alvarez, Cristina (Hospital Universitario Ramón y Cajal (Madrid))
Moral, Esperanza (Hospital General Universitario de Ciudad Real)
Ventura, Ana (Hospital Universitari i Politècnic La Fe (València))
Coca, Armando (Hospital Clínico Universitario)
Muñoz, Miguel-Angel (Hospital Virgen de la Salud (Toledo))
Hernández-Gallego, Román (Hospital Universitario de Badajoz)
Shabaka, Amir (Hospital Fundación Alcorcón)
Ledesma, Gabriel (Hospital Universitario Infanta Sofía)
Bouarich, Hanane (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Ángeles Rodríguez, María (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Pérez Tamajón, Lourdes (Hospital Universitario de La Laguna)
Cruzado, Leónidas (Hospital General Universitario de Elche)
Emilio Sánchez, José (Hospital Universitario de Cabueñes (Gijón))
Jiménez Jiménez, Carlos (Hospital Universitario La Paz (Madrid))
Universitat Autònoma de Barcelona

Títol variant:	Management of immunosuppressive therapy in kidney transplant recipients with COVID-19 : A multicentre national study derived from the Spanish Society of Nephrology COVID registry
Data:	2023
Resum:	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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Castellà
Document:	Article ; recerca ; Versió publicada
Matèria:	España ; Immunosuppression ; Inmunosupresión ; Kidney transplant ; SARS-CoV2 ; Spain ; Trasplante renal
Publicat a:	Nefrología (Badalona. English), Vol. 43 Núm. 4 (enero 2023) , p. 442-451, ISSN 2013-2514

DOI: 10.1016/j.nefroe.2023.08.004

10 p, 731.3 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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