Journal Article

Management of Kidney Transplant Outpatients With COVID-19: A Single Center Experience

Pokorná, Anita, Guňka, Igor, Pacovský, Jaroslav, Šafránek, Roman, Dusilová Sulková, Sylvie, Malá, Alena, Navrátil, Pavel, Matysková Kubišová, Michaela, Moučka, Petr, Heislerová, Marcela

2024

Overview

Patients undergoing kidney transplant are at risk of severe COVID-19. Our single-center retrospective analysis evaluated the outcomes of kidney transplant outpatients with COVID-19 who were managed with reduced immunosuppression and treatment with molnupiravir. Between January 2022 and May 2023, we included 93 patients (62 men, average age 56 years), serum creatinine 127 (101–153) µmol/L. Molnupiravir was administered, and immunosuppressive therapy was reduced immediately following the confirmation of SARS-CoV-2 infection by PCR, which was 2 (1–3) days after the onset of symptoms. Only three (3.2%) patients required hospitalization, and one patient died. Acute kidney injury was observed in two patients. During the follow-up period of 19 (15–22) months, there was no significant increase in proteinuria, no acute or new chronic graft rejection, and kidney graft function remained stable; serum creatinine was 124 (106–159) µmol/L post-COVID-19 infection and 128 (101–161) µmol/L at the end of the follow-up period. Our results demonstrate that early initiation of molnupiravir treatment combined with a temporary reduction in immunosuppressive therapy results in favorable clinical outcomes in patients with COVID-19, with preservation of good graft function and no episodes of graft rejection.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Aged / Ambulatory Care - methods / Ambulatory Care - statistics & numerical data / Antibodies / Antiviral Agents - administration & dosage / antiviral drugs / Biopsy / Body mass index / Calcineurin Inhibitors - administration & dosage / Calcineurin Inhibitors - adverse effects / Chronic obstructive pulmonary disease / Clinical outcomes / COVID-19 / COVID-19 - complications / COVID-19 - diagnosis / COVID-19 - immunology / COVID-19 - therapy / COVID-19 Drug Treatment - adverse effects / COVID-19 Drug Treatment - methods / COVID-19 Drug Treatment - statistics & numerical data / COVID-19 vaccines / Creatinine / Drug dosages / Feasibility Studies / Female / Follow-Up Studies / Graft rejection / Graft Rejection - epidemiology / Graft Rejection - immunology / Graft Rejection - prevention & control / Grafting / Health Archive / Hospitalization / Humans / Immunization / Immunocompromised Host / Immunosuppression / Immunosuppression Therapy - adverse effects / Immunosuppression Therapy - methods / Immunosuppression Therapy - statistics & numerical data / Immunosuppressive agents / Immunosuppressive Agents - administration & dosage / Immunosuppressive Agents - adverse effects / Incidence / Infections / Kidney Failure, Chronic - complications / Kidney Failure, Chronic - surgery / Kidney transplantation / Kidney Transplantation - adverse effects / Kidney transplants / Kidneys / Male / Middle Aged / molnupiravir / Mycophenolic Acid - administration & dosage / Mycophenolic Acid - adverse effects / Pandemics / Patients / Pneumonia / Proteinuria / Proteinuria - epidemiology / Proteinuria - etiology / Proteinuria - prevention & control / Rejection / Sars-CoV-2 / SARS-CoV-2 - immunology / SARS-CoV-2 - isolation & purification / Severe acute respiratory syndrome coronavirus 2 / Treatment Outcome / Viral diseases