Use of tocilizumab in kidney transplant recipients with COVID-19
María José Pérez-Sáez 1 , Miquel Blasco 2 , Dolores Redondo-Pachón 1 , Pedro Ventura Aguilar 2 , Teresa Bada-Bosch 3 , Isabel Pérez-Flores 4 , Edoardo Melilli 5 , Luis Alberto Sánchez-Cámara 6 , María Ovidia López-Oliva 7 , Cristina Canal 8 , Amir Shabaka 9 , Núria Garra Moncau 10 , Paloma Leticia Martín-Moreno 11 , Verónica López 12 , Román Hernández-Gallego 13 , Orlando Siverio 14 , Cristina Galeano 15 , Jordi Espí Reig 16 , Carlos Jesús Cabezas 17 , María Teresa Rodrigo 18 , Laura Llinàs-Mallol 1 , María José Fernández-Reyes 19 , Leónidas Cruzado Vega 20 , Lourdes Pérez-Tamajón 21 , Raquel Santana-Estupiñán 22 , María Carmen Ruiz-Fuentes 23 , Guadalupe Tabernero 24 , Sofía Zárraga 25 , Juan Carlos Ruiz 26 , Alex Gutiérrez-Dalmau 27 , Auxiliadora Mazuecos 28 , Emilio Sánchez-Álvarez 29 , Marta Crespo 1 , Julio Pascual 1 , Spanish Society of Nephrology COVID-19 Group; Isabel García-Méndez, Laureano Pérez-Oller, Martín Giorgi
Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin 6 (IL-6) release.
The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in COVID-19 patients. In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes.
We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (HR 3.12 for those older than 60 years, p=0.039). IL-6 and other inflammatory markers, including LDH, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in non-survivors.
Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in non-survivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [CI 1.004-1.024], p=0.003).
Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration, and did not impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.
CITA DEL ARTÍCULO Am J Transplant . 2020 Jul 12. doi: 10.1111/ajt.16192