Publicaciones científicas

Use of tocilizumab in kidney transplant recipients with COVID-19

12-jul-2020 | Revista: American Journal of Transplantation

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


Abstract

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

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