Half of patients showed chest radiographic evidence of bilateral infiltrates while the other half showed unilateral changes or no infiltrates

Half of patients showed chest radiographic evidence of bilateral infiltrates while the other half showed unilateral changes or no infiltrates. of 15 days [15-19] from symptom onset. These preliminary findings describe a rapid clinical deterioration associated with chest radiographic deterioration and escalating oxygen requirement in renal transplant recipients with SARS-Cov2 pneumonia. Thus, in this limited cohort of long-term kidney transplant patients, SARS-CoV-2 induced pneumonia is usually characterized by high risk of progression and significant mortality. of 19 patients)?Lopinavir/ritonavir15?Darunavir?+ ritonavir4Ventilation requirement at hospital admission?No oxygen7?LOR8?HOR5?NIV0?MV0 Open in a separate window ALT, alanine transaminase; AST, aspartate transaminase; CNI, calcineurin inhibitor; CPK, creatine phosphokinase; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; HCV, RG7713 hepatitis C computer virus; HOR, high oxygen requirement; LDH, lactate dehydrogenase; LOR, low oxygen requirement; MMF, mofetil mycophenolate; mTORi, mammalian target of rapamycin inhibitor; MV, mechanical ventilation; NIV, non-invasive ventilation; NV, normal value; SARS-CoV2, severe acute respiratory syndrome coronavirus 2; WBC, white blood cell. Data are reported as percentages or median (interquartile range) unless otherwise indicated. Unless specified, counts are from the total cohort ( em N /em ?= 20). aDetermined with the CKD Epidemiology Collaborations CKD-EPI equation. bPrednisone 5 mg/d or methylprednisolone 4 mg/d. Table?2 Clinical characteristics and outcome of 20 patients with COVID-19 infection who had undergone kidney transplantation thead th rowspan=”1″ colspan=”1″ Patient /th th rowspan=”1″ colspan=”1″ Age, yr/sex /th th rowspan=”1″ colspan=”1″ Tx date /th th rowspan=”1″ colspan=”1″ Comorbidities /th th rowspan=”1″ colspan=”1″ Respiratory and renal RG7713 involvement /th th rowspan=”1″ colspan=”1″ Baseline creatinine, mol/l (eGFR, ml/min per 1.73 m2) /th th rowspan=”1″ colspan=”1″ Baseline immunosuppression and treatment ( tocilizumab) /th th rowspan=”1″ colspan=”1″ ACEi or ARB /th th rowspan=”1″ colspan=”1″ Outcome /th /thead 170/F12/2002HypertensionNIV185 (23)CNI/mTORi br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquine br / DexamethasoneACEiDischarged247/F3/2011NoneICU, AKI, ARDS282 (16)MMF/CNI/low-dose steroids br / COVID treatment:?combination of lopinavir Rabbit Polyclonal to RHOBTB3 and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabACEiInpatient371/M1/2007Ischemic cardiac diseaseNIV, ARDS159 (37)MMF/CNI/low-dose steroids br / COVID treatment:?no antivirals or hydroxychloroquine br / DexamethasoneARBDeath457/M8/2018HCV infectionICU, ARDS141 (47)MMF/CNI/low-dose steroids br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabCDeath551/M3/1997Hypertension br / HCV infectionNIV221 (29)MMF/CNI br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabCDischarged646/M9/2017HypertensionNIV132 (55)MMF/CNI br / RG7713 COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquine br / DexamethasoneCDischarged759/M2/2015HypertensionICU, ARDS256 (23)MMF/CNI/low-dose steroids br / COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquine br / DexamethasoneACEiDeath870/F7/2004HypertensionICU, AKI, ARDS300 (13)CNI/low-dose steroids br / COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquine br / DexamethasoneACEiDeath960/M10/2011HypertensionRoom air150 (43)MMF/CNI/low-dose steroids br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquineACEiInpatient1073/M9/2013Hypertension br / DiabetesNIV, ARDS132 (46)MMF/CNI/low-dose steroids br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquineACEiInpatient1159/M3/2010Hypertension br / Ischemic cardiac disease br / DiabetesNIV, AKI, ARDS238 (25)MMF/low-dose steroids br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabARBInpatient1263/M8/2004HypertensionNIV, ARDS203 (29)MMF/CNI br / COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabCDeath1349/M6/2018HypertensionNIV, AKI, ARDS185 (36)MMF/CNI/low-dose steroids br / COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquine br / Dexamethasone br / TocilizumabCInpatient1460/F6/2018HypertensionNIV, ARDS106 (49)MMF/CNI/low-dose steroids br / COVID treatment:?combination of lopinavir and ritonavir, hydroxychloroquineCInpatient1557/M6/2009HypertensionRoom air106 (67)MMF/CNI br / COVID RG7713 treatment:?combination of lopinavir and ritonavir, hydroxychloroquineCInpatient1654/M10/2002HypertensionNIV, AKI, ARDS344 (16)CNI/low-dose steroids br / COVID treatment:?darunavir, ritonavir, and hydroxychloroquineARBInpatient1760/M4/2007Hypertension br / Ischemic cardiac diseaseRoom air141 (46)CNI br / COVID treatment: combination of lopinavir and ritonavir, hydroxychloroquineCInpatient1850/M11/2010HypertensionRoom air123 (58)MMF/CNI/low-dose steroids br / COVID treatment:?darunavir, ritonavir, and hydroxychloroquineCInpatient1969/M7/1998Hypertension br / DiabetesAKI309 (17)CNI/low-dose steroids br / COVID treatment:?darunavir, ritonavir, and hydroxychloroquineCInpatient2044/M7/2006HypertensionRoom air114 (66)CNI mTORi br / COVID treatment:?darunavir, ritonavir, and hydroxychloroquineCInpatient Open in a separate windows ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; ARDS, acute respiratory distress syndrome; AKI, acute kidney injury; CNI, calcineurin inhibitor; COVID-19, coronavirus disease 2019; eGFR, estimated glomerular filtration rate; F, female; HCV, hepatitis C computer virus; ICU, intensive care unit; M, male, MMF, mycophenolate mofetil; mTORi, mammalian target of rapamycin inhibitor; NIV, non-invasive ventilation; Tx, transplant. All patients had their usual transplant immunosuppression withdrawn and were started RG7713 on methylprednisolone 16 mg or comparative dose of prednisone, and 19 of the 20 received antiviral therapy and hydroxychloroquine as per our protocol.2 As antiviral therapy is known to interfere with calcineurin inhibitor metabolism, in 4 patients, tacrolimus levels were monitored after these therapeutic changes were instituted. The median trough values before antiviral therapy were 7.05 ng/ml (IQR, 5.5C8.6): 1 patient had the level rechecked after 3 days with no change compared with baseline; 1 patient had the level rechecked 4 and 5 days after admission (?17% and??18% compared with baseline); 1 was rechecked 6 days after admission (?12% compared with baseline); and 1 was rechecked 8 days after admission (?21%.