Immunsuppression bei COVID-19 nach Nierentransplantation

ZUSAMMENFASSUNG

Das SARS-CoV2-Virus (SARS-CoV-2: „severe acute respiratorysyndrome coronavirus 2“) und die dadurch ausgelöste COVID-19-Erkrankung (COVID-19: „corona virus disease of 2019“) stellen ein erhebliches Risiko für Patienten nach einer Nierentransplantation dar, da in dieser Personengruppe viele Betroffene an fortgeschrittenen Organdysfunktionen und hoher Komorbidität leiden. Damit verbunden ist eine erhöhte Wahrscheinlichkeit für einen schweren Verlauf oder einen tödlichen Ausgang nach einer SARS-CoV-2-Infektion in dieser stark immunsupprimierten Patientengruppe. Neben den häufig bestehenden Komorbiditäten kann die erforderliche therapeutische Immunsuppression zu einer über 20-prozentigen Mortalität nach der Nierentransplantation führen. Die klinische Symptomatik und etablierte Risikofaktoren wie in der Allgemeinbevölkerung unterstützen diese Erkenntnisse. Es stellt sich die Frage, wie die immunsuppressive Therapie an die Behandlung von Menschen angepasst werden sollte, die nach einer Nierentransplantation an COVID-19 erkranken. Hierzu werden derzeit noch zahlreiche Studien ausgewertet, Empfehlungen für diese Erkrankungssituation sind in diesem Beitrag zusammengefasst.

Publication History

Article published online:
15 October 2024

• Literatur

• 1 Ajamy M, Liriano-Ward L, Graham JA. et al. Risks and benefits of kidney transplantation during COVID-19 pandemic: Transplant or not transplant?. Kidney 360 2021; 2: 1179-1187
• 2 Bossini N, Alberic iF, Delbarba E. et al. Kidney transplant patients with SARS-coV-2 infection: the Brescia renal COVID task force experience. Am J Transplant 2020; 20: 3019-3029
• 3 Caillard S, Anglicheau D, Matignon M. et al. An initial report from the French SOT COVID registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Kidney Int 2020; 98: 1549-1558
• 4 Cravedi P, Mothi SS, Azzi Y. et al. COVID-19 and kidney transplantation: results from the TANGO international transplant consortium. Am J Transplant 2020; 20: 3140-3148
• 5 Elias M, Pievani D, Randoux C. et al. COVID-19 infection in kidney transplant recipients: disease incidence and clinical outcomes. J Am Soc Nephrol 2020; 31: 2413-2423
• 6 Favà A, Cucchiari D, Montero N. et al. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: a multicentric cohort study. Am J Transplant 2020; 20: 3030-3041
• 7 Maggiore U, Abramowicz D, Crespo M. et al. How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion. Nephrol Dial Transplant 2020; 35: 899-904
• 8 Lubetzky M, Aull MJ, Craig-Schapiro R. et al. Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center. Nephrol Dial Transplant 2020; 35: 1250-1261
• 9 Mehta SA, Leonard J, Labella P. et al. Outpatient management of kidney transplant recipients with suspected COVID-19-single-center experience during the New York City surge. Transpl Infect Dis 2020; 22: e13383
• 10 Bossini N, Alberici F, Delbarba E. et al. Kidney transplant patients with SARS-coV 2 infection: the Brescia renal COVID task force experience. Am J Transplant 2020; 20: 3019-3029
• 11 Hilbrands LB, Vart P, Franssen CFM. et al. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrol Dial Transplant 2020; 35: 1973-1983
• 12 Regele F, Oberbauer R.. COVID-19 und Nierentransplantation,. Nephrologe 2021; 16: 129-137
• 13 Akalin E, Azzi Y, Bartash R. et al. COVID-19 and kidney transplantation. N Engl J Med 2020; 382: 2475-2477
• 14 Cheng Y, Luo R, Wang K. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97: 829-838
• 15 Hirsch JS, Ng JH, Ross DW. et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int 2020; 98: 209-218
• 16 Pei G, Zhang Z, Peng J. et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol 2020; 31: 1157-1165
• 17 Farkash EA, Wilson AM, Jentzen JM.. Ultrastructural evidence for direct renal infection with SARS-CoV-2. J Am Soc Nephrol 2020; 31: 1683-1687
• 18 Su H, Yang M, Wan C. et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int 2020; 98: 219-227
• 19 Cummings MJ, Baldwin MR, Abrams D. et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020; 395: 1763-1770
• 20 Gajurel K.. Persistently positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal PCR in a kidney transplant recipient Transpl Infect Dis. 2020
• 21 Zhu L, Gong N, Liu B. et al. Coronavirus disease 2019 pneumonia in immunosuppressed renal transplant recipients: a summary of 10 confirmed cases in Wuhan, China. Eur Urol 2020; 77: 748-754
• 22 Benotmane I, Gautier-Vargas G, Wendling MJ. et al. In-depth virological assessment of kidney transplant recipients with COVID-19. Am J Transplant 2020; 20: 3162-3172
• 23 Nicastro E, Verdoni L, Bettini LR. et al. COVID-19 in immunosuppressed children. Front Pediatr 2021; 9: 629240
• 24 Huet T, Beaussier H, Voisin O. et al. Anakinra for severe forms of COVID-19: a cohort study. Lancet 2020; 2: e393-e400
• 25 Husain SA, Dube G, Morris H. et al. Early outcomes of outpatient management of kidney transplant recipients with coronavirus disease 2019. Clin J Am Soc Nephrol 2020; 15: 1174-1178
• 26 Ioannidis JPA.. Global perspective of COVID-19 epidemiology for a full-cycle pandemic. Eur J Clin Invest 2020; 50: e13423
• 27 Keller MJ, Kitsis EA, Arora S. et al. Effect of systemic glucocorticoids on mortality or mechanical ventilation in patients with COVID-19. J Hosp Med 2020; 15: 489-493
• 28 Lechien JR, Chiesa-Estomba CM, Place S. et al. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med 2020; 288: 335-344
• 29 Leisman DE, Ronner L, Pinotti R. et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med 2020; 8: 1233-1244
• 30 Li H, Chen C, Hu F. et al. Impact of corticosteroid therapy on outcomes of persons with SARS-CoV 2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis. Leukemia 2020; 34: 1503-1511
• 31 Perico L, Benigni A, Casiraghi F. et al. Immunity, endothelial injury and complement-induced coagulopathy in COVID-19. Nat Rev Nephrol 2021; 17: 46-64
• 32 Ragab D, Salah Eldin H, Taeimah M. et al. The COVID-19 cytokine storm; what we know so far. Front Immunol 2020; 11: 1446
• 33 RECOVERY Collaborative Group. Effect of hydroxychloroquine in hospitalized patients with COVID-19. N Engl J Med 2020; 283: 2030-2040
• 34 RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19 – preliminary report. N Engl J Med 2021; 384: 693-704
• 35 Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020; 395: 473-475
• 36 Simonovich VA, Burgos Pratx LD, Scibona P. et al. A randomized trial of convalescent plasma in COVID-19 severe pneumonia. N Engl J Med 2021; 84: 619-629
• 37 Crespo M, Mazuecos A, Rodrigo E. et al. Respiratory and gastrointestinal COVID-19 phenotypes in kidney transplant recipients. Transplantation 2020; 104: 2225-2233
• 38 Benotmane I, Perrin P, Gautier Vargas G. et al. Biomarkers of cytokine release syndrome predict disease severity and mortality from COVID-19 in kidney transplant recipients. Transplantation 2021; 105: 158-169
• 39 Demir E, Uyar M, Parmaksiz E. et al. COVID-19 in kidney transplant recipients: a multicenter experience in Istanbul. Transpl Infect Dis 2020; 22: e13371
• 40 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the treatment of COVID-19 – final report. N Engl J Med 2020; 383: 1813-1826
• 41 WHO Solidarity Trial Consortium Pan H, Peto R. et al. Repurposed antiviral drugs for COVID-19 – interim WHO solidarity trial results. N Engl J Med 2021; 384: 497-511
• 42 Cao B, Wang Y, Wen D. et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med 2020; 382: 1787-1799
• 43 Sterne JAC, Murthy S, Diaz JV. et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA 2020; 324: 1330-1341
• 44 Sinha P, Matthay MA, Calfee CS.. Is a “cytokine storm” relevant to COVID-19?. JAMA Intern Med 2020; 180: 1152-1154
• 45 Caillard S, Chavarot N, Francois H. et al. Is COVID-19 infection more severe in kidney transplant recipients? French SOT COVID Registry. Am J Transplant 2021; 21: 1295-1303
• 46 Ravanan R, Callaghan CJ, Mumford L. et al. SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study. Am J Transplant 2020; 20: 3008-3018
• 47 Hilbrands LB, Duivenvoorden R, Vart P. et al. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrol Dial Transplant 2020; 35: 1973-1983
• 48 Craig-Schapiro R, Salinas T, Lubetzky M. et al. COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients. Am J Transplant 2021; 21: 1576-1585
• 49 Clarke JM, Majeed A, Beaney T.. Measuring the impact of covid-19. BMJ 2021; 373: n1239
• 50 Mamode N, Ahmed Z, Jones G. et al. Mortality rates in transplant recipients and transplantation candidates in a high-prevalence COVID-19 environment. Transplantation 2021; 105: 212-215
• 51 Mohamed K, Rzymski P, Islam MS. et al. COVID-19 vaccinations: The unknowns, challenges, and hopes. J Med Virol 2022; 94: 1336-1349