Use of tocilizumab in kidney transplant recipients with COVID‐19

• Published in: American Journal of Transplantation Vol. 20; no. 11; pp. 3182 - 3190
• Main Authors: Pérez‐Sáez, María J., Blasco, Miquel, Redondo‐Pachón, Dolores, Ventura‐Aguiar, Pedro, Bada‐Bosch, Teresa, Pérez‐Flores, Isabel, Melilli, Edoardo, Sánchez‐Cámara, Luis A., López‐Oliva, María O., Canal, Cristina, Shabaka, Amir, Garra‐Moncau, Núria, Martín‐Moreno, Paloma L., López, Verónica, Hernández‐Gallego, Román, Siverio, Orlando, Galeano, Cristina, Espí‐Reig, Jordi, Cabezas, Carlos J., Rodrigo, María T., Llinàs‐Mallol, Laura, Fernández‐Reyes, María J., Cruzado‐Vega, Leónidas, Pérez‐Tamajón, Lourdes, Santana‐Estupiñán, Raquel, Ruiz‐Fuentes, María C, Tabernero, Guadalupe, Zárraga, Sofía, Ruiz, Juan C, Gutiérrez‐Dalmau, Alex, Mazuecos, Auxiliadora, Sánchez‐Álvarez, Emilio, Crespo, Marta, Pascual, Julio
• Format: Journal Article Web Resource
• Language: English
• Published: United States John Wiley & Sons, Inc 01.11.2020; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Adult; Antibodies, Monoclonal, Humanized - therapeutic use; Brief Communication; Brief Communications; clinical research/practice; Clinical trials; Comorbidity; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - epidemiology; Cytokine storm; Cytokines; Female; Ferritin; Follow-Up Studies; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Humans; Immune response; Immunosuppressive agents; Incidence; infection and infectious agents ‐ viral; Inflammation; Kidney Transplantation; kidney transplantation/nephrology; Kidney transplants; Lactic acid; Male; Middle Aged; Monoclonal antibodies; Multivariate analysis; Pandemics; patient survival; Respiratory distress syndrome; Retrospective Studies; SARS-CoV-2; Spain - epidemiology; Treatment Outcome; Young Adult; Spain; patient survival; infection and infectious agents - viral; clinical research/practice; kidney transplantation/nephrology
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.16192

Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin‐6 (IL‐6) release. The IL‐6‐receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID‐19) . In this pandemic, kidney transplant (KT) recipients are a high‐risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID‐19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL‐6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D‐dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C‐reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004‐1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID‐19 but randomized trials are needed. This multicenter study reports the outcomes of kidney transplant patients treated with tocilizumab for COVID‐19, showing a mortality rate of 32.5% and higher levels of C‐reactive protein early after tocilizumab administration for patients with poor outcomes.