Recommendations of the Colombian Association of Nephrology in renal transplantation during the coronavirus pandemic (COVID-19)
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Keywords

COVID-19, SARS-Cov 2, coronavirus, betacoronavirus, kidney transplantation, renal transplantation, kidney grafting

How to Cite

1.
Torres Serrano R, Montero Cetina C, Benavides C, Malaver N, García Padilla P, Acevedo A, Olivares Algarin O, Hernández A. Recommendations of the Colombian Association of Nephrology in renal transplantation during the coronavirus pandemic (COVID-19): . Rev. Colomb. Nefrol. [Internet]. 2020 Apr. 30 [cited 2022 Sep. 24];7(Supl.2). Available from: https://revistanefrologia.org/index.php/rcn/article/view/447

Abstract

Introduction: Kidney transplant patients are a high-risk population for complications and mortality associated with SARS CoV2 infection. Different reports in the literature have shown a higher frequency of respiratory compromise and mortality, currently don’t exist recommendations with an adequate level of evidence regarding the management of base immunosuppression and treatment strategies in this population, for which reason it is necessary from the national scene, build recommendations based on the available evidence and consensus of experts, to be applied at the local level.

Objective: To develop, by means of an expert consensus and a review of the available literature, recommendations for the prevention, diagnosis and management of transplant patients with SARS Cov2 infection. And give recommendations to continue with the organ procurement and transplant activity in the scenario of the COVID-19 pandemic.

Materials and methods: Questions were asked about SARS Cov2 infection in kidney transplantation, with emphasis on clinical behavior, frequency of infection, prevention, diagnosis, management of immunosuppression and treatment. A search of the literature in Pubmed, Embase and scientific societies was performed to answer each of the questions. The discussion of the answers to each of the questions
according to the available evidence and the possibility of adapting them to local practice was carried out by consensus method and panel of experts. Nephrology and transplant surgery specialists from transplant groups in the country participated in the consensus.

Results: A panel of experts was held to discuss the questions and answers found in the literature between April 23, 2020 and May 10, 2020, for each question a panel discussion was held where the total of experts discussed and Evaluates the quality of the evidence to issue a final recommendation on each evaluated point. A consolidation of the main series of cases of SARS-CoV2 infection in the kidney transplant population and the clinical outcomes was carried out up to the moment of publication.

Conclusions: According to what is found in the literature, recommendations are made for the prevention, diagnosis and management of patients with kidney transplantation and SARS-CoV2 infection, emphasizing behavior with respect to basic immunosuppressive management, and highlighting the importance of the pharmacological interactions of the available treatments for SARS-CoV2 with immunosuppressive therapy, recommendations are also given to implement the procupara and transplant activity safely during the pandemic.

https://doi.org/10.22265/acnef.7.Supl.2.447
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References

Gandolfini I, Delsante M, Fiaccadori E, Zaza G, Manenti L, Degli-Antoni A, et al. COVID-19 in Kidney Transplant Recipients. Am J Transplant. 2020;20(7):1941-3. https://doi.org/10.1111/ajt.15891.

Sociedad Española de Nefrología (SEN). Registros de la S.E.N. Resgitro COVID-19. Informe 14. SEN; 2020 [citado Agosto 15 2020]. Disponible en: https://mailchi.mp/senefro/registro-epidemiolgico-vhc-vhb-vih-1314718.

Saavedra-Trujillo CH.Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-CoV2/COVID-19 en estable- cimientos de atención en salud. Recomendaciones basadas en consenso de expertos e informadas en la evidencia. Infectio. 2020;24(3 Suppl 1). http://dx.doi.org/10.22354/in.v24i3.851.

Centers for Disease Control and Prevention (CDC). People With Certain Medical Conditions. CDC;2020 [citado Agosto 15 2020]. Dosponible en: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html.

Fernández-Ruiz M, Andrés A, Loinaz C, Delgado JF, López-Medrano F, San Juan R, et al. COVID-19 in solid organ transplant recipients: a single-center case series from Spain. Am J Transplant]. 2020;20(7):1849-58. https://doi.org/10.1111/ajt.15929.

Pereira M, Mohan S, Cohen D, Husain SA, Dube GK, Ratner LE, et al. COVID-19 in solid organ transplants recipients: initial report from the US epicenter. Am J Transplant. 2020;20(7):1800-8. https://doi.org/10.1111/ajt.15941.

Columbia University Kidney Transplant Program. Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York. J Am Soc Nephrol. 2020;31(6):1150-6. https://doi.org/10.1681/ASN.2020030375

Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, et al. Covid-19 and Kidney Transplantation. N Engl J Med. 2020;382(25):2475-7. https://doi.org/10.1056/NEJMc2011117

Su H, Yang M, Wan Ch, Fogo AB, Nie X, Zhang C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID 19 in China. Kidney Int. 2020;98(1):219-27. https://doi.org/10.1016/j.kint.2020.04.003

Guan W, Ni Z, Hu Y, Liang W, OU C, He K, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032

Fishman JA, Grossi PA. Novel Coronavirus-19 (COVID-19) in the Immunocompromised Transplant Recipient: #Flatteningthecurve. Am J Transplant. 2020;20(7):1765-7. https://doi.org/10.1111/ajt.15890

Zhang H, Chen Y, Yuan Q, Xia QX, Zeng XP, Peng JT, et al. Identification of Kidney Transplant Recipients with Coronavirus Disease 2019. Eur Urol. 2020;77(6):742-7. https://doi.org/10.1016/j.eururo.2020.03.030

Guillen E, Pineiro GJ, Revuelta I, Rodriguez D, Bodro M, Moreno A, et al. Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation? Am J Transplant. 2020;20(7):1875-8. https://doi.org/10.1111/ajt.15874

Romanelli A, Mascolo S. Inmmunosuppresion drug- related and clinical manifestations of coronavirus disease 2019 a therapeutical hypothesis Am J Transplant. 2020;20(7):1947-8. https://doi.org/10.1111/ajt.15905

Health Resources and Services Administration (HRSA). Information for transplant programs and OPOs regarding 2019 Novel Coronavirus. Richmond: HRSA; 2020 [citado agosto 23 2020]. Disponible en: https://optn.transplant.hrsa.gov/news/information-for-transplant- programs-and-opos-regarding-2019-novel-coronavirus/.

Ahn C, Amer H, Anglicheau D, Ascher N, Baan C, Bat-Ireedui B, et al. Global Transplantation COVID Report March 2020. Transplantation. 2020. https://doi.org/10.1097/TP.0000000000003258

Boëlle PY, Souty C, Launay T, Guerrisi C, Turbelin C, Behillil S, et al. Excess cases of influenza-like illnesses synchronous with coronavirus disease (COVID-19) epidemic, France, March 2020. Euro Surveill. 2020;25(14):2000326. https://doi.org/10.2807/1560-7917.ES.2020.25.14.2000326

Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4. https://doi.org/ 10.1186/s40779-020-0233-6

Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020;20(7):1859-63. https://doi.org/10.1111/ajt.15869.

Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, et al. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int. 2020;97(6):1083-8 https://doi.org/10.1016/j.kint.2020.04.002

Huang J, Lin H, Wu Y, Fang Y, Kumar R, Chen G, et al. COVID-19 in posttransplant patients—report of 2 cases. Am J Transplant. 2020;20(7):1879-81. https://doi.org/10.1111/ajt.15896

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4. http://dx.doi.org/10.1016/S0140-6736(20)30628-0

Chan JFW, Yao Y, Yeung ML, Deng W, Bao L, Jia L, et al. Treatment with lopinavir/ritonavir or interferon-?1b improves outcome of MERS-CoV infection in a nonhuman primate model of common marmoset J Infect Dis. 2015;212(12):1904-13. https://doi.org/10.1093/infdis/jiv392

Willicombe M, Thomas D, Mcadoo S. COVID-19 and Calcineurin Inhibitors?: Should They Get Left Out in the Storm?? J Am Soc Nephrol. 2020;31(6):1145-6. https://doi.org/10.1681/ASN.2020030348

Carbajo-Lozoya J, Ma-Lauer Y, Maleševi? M, Theuerkorn M, Kahlert V, Prell E, et al. Human coronavirus NL63 replication is cyclophilin A-dependent and inhibited by non-immunosuppressive cyclosporine A-derivatives including Alisporivir. Virus Res. 2014;184:44-53. https://doi.org/10.1016/j.virusres.2014.02.010

Carbajo-Lozoya J, Müller MA, Kallies S, Thiel V, Drosten C, Von Brunn A. Replication of human coronaviruses SARS-CoV, HCoV- NL63 and HCoV-229E is inhibited by the drug FK506. Virus Res. 2012;165(1):112-7. https://doi.org/10.1016/j.virusres.2012.02.002

Ventura-Aguiar P, Campistol JM, Diekmann F. Safety of mTOR inhibitors in adult solid organ transplantation. Expert Opin Drug Saf. 2016;15(3):303-19. https://doi.org/10.1517/14740338.2016.1132698

Zaza G, Tomei P, Ria P, Granata S, Boschiero L, Lupo A. Systemic and nonrenal adverse effects occurring in renal transplant patients treated with mTOR inhibitors. Clin Dev Immunol. 2013;2013:403280. https://doi.org/10.1155/2013/403280.

Huang CT, Hung CY, Chen TC, Lin CY, Lin YC, Chang CS, et al. Rapamycin adjuvant and exacerbation of severe influenza in an experimental mouse model. Sci Rep. 2017;7:4136. https://doi.org/10.1038/s41598-017-04365-6

Lansbury LE, Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Shen-Lim W. Corticosteroids as Adjunctive Therapy in the Treatment of Influenza: An Updated Cochrane Systematic Review and Meta-analysis. Crit Care Med. 2020;48(2):e98-106. https://doi.org/10.1097/CCM.0000000000004093

Ma Y, Diao B, Lv X, Zhu J, Liang W, Liu L, et al. COVID-19 in hemodialysis (HD) patients: Report from one HD center in Wuhan, China. https://doi.org/10.1101/2020.02.24.20027201

Rosselli D. Covid 19 en Colombia: los primeros 90 días. Acta Neurol Colomb. 2020;36(2):1-6. https://doi.org/10.22379/24224022286

Elens L, Langman LJ, Hesselink DA, Bergan S, Moes DJAR, Molinaro M, et al. Pharmacologic treatment of transplant recipients infected with SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug-Drug Interactions. Ther Drug Monit. 2020;42(3):360-8. https://doi.org/10.1097/FTD.0000000000000761

Patel AN, Desai SS, Grainger DW, Mehra MR. Usefulness of Ivermectin in COVID-19 Illness. DEEMAGCLINIC; 2020.

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020;178:104787. https://doi.org/10.1016/j.antiviral.2020.104787

Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-87. https://doi.org/10.1007/s00134-020-06022-5

López V, Vázquez T, Alonso-Titos J, Cabello M, Alonso A, Beneyto I, et al. Recomendaciones en el manejo de la pandemia por coronavirus SARS-CoV-2 (Covid-19) en pacientes con trasplante renal. Nefrología. 2020;40(3):265-71. https://doi.org/10.1016/ j.nefro.2020.03.002

World Health Organization (WHO). Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: interim guidance, 2 March 2020. Geneva: WHO;. 2020. Disponible en: https://apps.who.int/iris/handle/10665/331329

Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real- time RT-PCR. Euro Surveill 2020;25(3):2000045. https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045

Chu DKW, Pan Y, Cheng SMS, Hui KPY, Krishnan P, Liu Y, et al. Molecular Diagnosis of a Novel Coronavirus (2019-nCoV) Causing an Outbreak of Pneumonia. Clin Chem. 2020;66(4):549-55. https://doi.org/10.1093/clinchem/hvaa029.

Centers for Disease Control and Prevention (CDC). CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Panel. Atlanta: CDC; 2020 [citado Agosto 23 2020]. Disponible en: https://www.fda.gov/media/134922/download

Ogimi C, Greninger AL, Waghmare AA, Kuypers JM, Shean RC, Xie H, et al. Prolonged shedding of human coronavirus in hematopoietic cell transplant recipients: Risk factors and viral genome evolution. J Infect Dis. 2017;216(2):203-9. https://doi.org/10.1093/infdis/ jix264

Liu L, Liu W, Wang S, Zheng S. A preliminary study on serological assay for severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) in 238 admitted hospital patients. medRxiv. 2020. https://doi.org/10.1101/2020.03.06.20031856

Massachusetts General Hospital. Massachusetts General Hospital COVID-19 Treatment Guidance. Massachusetts: Massachusetts General Hospital; 2020 [citado Agosto 23 2020]. Disponible en: https://www.aamc.org/system/files/2020-03/hca-document-MGH- COVID-19-Treatment-Guidelines-3-24-20.pdf

Sociedad Española de Nefrología (SEN). Registros de la S.E.N. Resgitro COVID-19. Informe 3. SEN; 2020 [citado Agosto 15 2020]. Disponible en: https://mailchi.mp/senefro/registro-epidemiolgico-vhc-vhb-vih-1314533

ERACODA. The ERA-EDTA COVID-19 Database for patients on kidney replacement therapy. ERACODA; 2020 [citado Agosto 15 2020]. Disponible en: https://www.era-edta.org/en/wp-content/uploads/2020/04/ERACODA_Study_Report_2020-04-15.pdf

Prachand VN, Milner R, Angelos P, Posner MC, Fung JJ, Agrawal N, et al. Medically Necessary, Time-Sensitive Procedures: Scoring Systemto Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19Pandemic. J Am Coll Surg. 2020;231(2);281-8. https://doi.org/10.1016/j.jamcollsurg.2020.04.011

American College of Surgeons. COVID 19: Considerations for Optimum Surgeon Protection: Before, During, and After Operation. 2020 [citado Agosto 14 2020]. Disponible en: https://www.facs.org/-/media/files/covid19/considerations_optimum_surgeon_protection.ashx

Colombia. Ministerio de Salud y Portección Social (Minsalud). Recomendaciones de EPP para personal de salud según el área de atención para COVID-19. Consenso IETS- ACIN. Bogotá D.C.: Minsalud; 2020 [citado Agosto 15 2020]. Disponible en: https:// www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/tabla-epp-consenso.pdf.

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