Favipiravir in Kidney Transplant Recipients With COVID-19: A Romanian Case Series

• Published in: Transplantation proceedings Vol. 54; no. 6; pp. 1489 - 1493
• Main Authors: Cismaru, Cristina, Elec, Alina Daciana, Muntean, Adriana, Moisoiu, Tudor, Lupșe, Mihaela, Antal, Oana, Elec, Florin Ioan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: Adult; Amides; Antiviral Agents - adverse effects; COVID-19 Drug Treatment; Creatinine; Female; Humans; Kidney Transplantation - adverse effects; Middle Aged; Oxygen; Pyrazines; Retrospective Studies; RNA-Dependent RNA Polymerase; Romania; SARS-CoV-2; Transaminases; Transplant Recipients; Treatment Outcome; Romania
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2021.12.011

Favipiravir (FPV) is an orally administrable antiviral drug that selectively inhibits RNA-dependent RNA polymerase and has been repurposed for COVID-19 treatment. There is limited information on the use of FPV in kidney transplant recipients (KTx), who often have multiple comorbidities and run a higher risk for death from COVID-19. We retrospectively reviewed all KTx at our institution who got sick with COVID-19 between March 1, 2020, and May 31, 2021, and who received FPV (loading dose of 1800 mg × 2 on day 1, maintenance dose 2  ×  800 mg/d for 5-14 days) as part of their COVID treatment. We analyzed demographics, clinical course, laboratory data, management, and outcome. Nine KTx with COVID-19 received FPV; all were hospitalized. The median age was 52 years (range, 32-60 years), and women were predominant (77.7%). Eight KTx had pulmonary involvement on chest radiograph. On admission 1 patient had mild, 5 had moderate, 2 had severe, and 1 had critical disease. Leukopenia and increased creatinine were universally noted. Three patients had disease progression under treatment. Seven patients (77.7%) required additional oxygen, and 4 (57.1%) needed intensive care unit admission. Three KTx died, resulting in an overall mortality of 33.3%. Survivors did not show increased transaminases or creatinine during or after FPV treatment; leukocytes, neutrophils, and platelets improved on discharge compared with admission values. FPV appears well tolerated by KTx with COVID-19, but its clinical benefit remains unclear. Larger analyses are needed.