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Use of tocilizumab in kidney transplant recipients with COVID-19

2020; Elsevier BV; Volume: 20; Issue: 11 Linguagem: Inglês

10.1111/ajt.16192

1600-6143

María José Pérez‐Sáez, Miquel Blasco, Dolores Redondo‐Pachón, Pedro Ventura‐Aguiar, Teresa Bada-Bosch, Isabel Pérez-Flores, Edoardo Melilli, Luis Sánchez-Cámara, María O. López‐Oliva, Cristina Canal, Amir Shabaka, Núria Garra-Moncau, Paloma Leticia Martín-Moreno, Verónica López, Román Hernández‐Gallego, Orlando Siverio, C. Galéano, Jordi Espí-Reig, Carlos J. Cabezas, M.T. Fernández, Laura Llinàs-Mallol, María José Fernández‐Reyes, Leónidas Cruzado-Vega, Lourdes Pérez Tamajón, Raquel Santana‐Estupiñán, María Carmen Ruiz-Fuentes, Guadalupe Tabernero, Sofía Zárraga, Juan Carlos Ruiz, Álex Gutiérrez-Dalmau, Auxiliadora Mazuecos, Emilio Sánchez-Álvarez, Marta Crespo, Julio Pascual,

Muscle and Compartmental Disorders

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 patients with coronavirus disease 2019 (COVID-19) . 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 (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. 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 nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed. 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 patients with coronavirus disease 2019 (COVID-19) . 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 (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. 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 nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.