Covid-19 in kidney transplant recipients

Czech version

Authors: Mária Magicová; Ondřej Viklický
Authors‘ workplace: Klinika nefrologie, Transplantační centrum, Institut klinické a experimentální medicíny, Praha
Published in: Vnitř Lék 2022; 68(7): 444-448
Category: Main Topic
doi: https://doi.org/10.36290/vnl.2022.093

Overview

Kidney transplant recipients are a very vulnerable population at risk of severe course and death from Covid-19. Several antiviral drugs are now available for the treatment of nonhospitalized individuals with mild to moderate Covid-19 and hospitalized patients with severe disease. The combination of monoclonal antibodies is also available to be used as pre-exposure prophylaxis in elderly patients.

Previously used monoclonal antibodies for post-exposure prophylaxis are no longer effective because of the new mutations and are no longer recommended. Although the immune response to Covid-19 vaccines is impaired in kidney transplant recipients, the effectiveness of the Covid-19 vaccines was described even in this immunocompromised group. Therefore vaccination, together with anti-epidemic measures, remains the most important tool to prevent Covid-19.

Keywords:

vaccination – Monoclonal antibodies – kidney transplantation – COVID-19 – antiviral drugs – vaccine effectiveness – mRNA vaccine – pre‑exposure prophylaxis – SARS‑CoV- 2 – vector vaccine

Sources

1. Information on COVID-19 Treatment, Prevention and Research. COVID-19 Treatment Guidelines. [cited June 2022]. Avalible from: https://www.covid19treatmentguidelines.nih.gov/

2. Gottlieb RL, Vaca CE, Paredes R et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2022;386(4):305-315.

3. Ackley TW, McManus D, Topal JE, Cicali B, Shah S. A Valid Warning or Clinical Lore: an Evaluation of Safety Outcomes of Remdesivir in Patients with Impaired Renal Function from a Multicenter Matched Cohort. Antimicrob Agents Chemother. 2021;65(2):e02290-20.

4. Jayk Bernal A, Gomes da Silva MM, Musungaie DB et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. 2022;386(6):509-520.

5. Takashita E, Kinoshita N, Yamayoshi S, et al. Efficacy of Antibodies and Antiviral Drugs against Covid-19 Omicron Variant. N Engl J Med. 2022;386(10):995-998.

6. Hammond J, Leister‑Tebbe H, Gardner A et al. Oral Nirmatrelvir for High‑Risk, Nonhospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542.

7. Beigel JH, Tomashek KM, Dodd LE et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813-1826.

8. RECOVERY Collaborative Group, Horby P, Lim WS et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704.

9. Prendecki M, Clarke C, Gleeson S et al. Detection of SARS‑CoV- 2 Antibodies in Kidney Transplant Recipients. J Am Soc Nephrol. 2020;31(12):2753-2756.

10. Magicova M, Fialova M, Zahradka I et al. Humoral response to SARS‑CoV- 2 is well preserved and symptom dependent in kidney transplant recipients. Am J Transplant. 2021;21(12):3926-3935.

11. Bertrand D, Hamzaoui M, Drouot L et al. SARS‑CoV- 2-specific Humoral and Cellular Immunities in Kidney Transplant Recipients and Dialyzed Patients Recovered From Severe and Nonsevere COVID-19. Transplant Direct. 2021;7(12):e792.

12. Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody Response to 2-Dose SARS‑CoV- 2 mRNA Vaccine Series in Solid Organ Transplant Recipients. JAMA. 2021;325(21):2204-2206.

13. Magicova M, Zahradka I, Fialova M et al. Determinants of Immune Response to Anti‑SARS‑CoV- 2 mRNA Vaccines in Kidney Transplant Recipients: A Prospective Cohort Study. Transplantation. 2022;106(4):842-852.

14. Chavarot N, Ouedrani A, Marion O et al. Poor Anti‑SARS‑CoV- 2 Humoral and T‑cell Responses After 2 Injections of mRNA Vaccine in Kidney Transplant Recipients Treated With Belatacept. Transplantation. 2021;105(9):e94-e95.

15. Li P, Wang Y, Lavrijsen M et al. SARS‑CoV- 2 Omicron variant is highly sensitive to molnupiravir, nirmatrelvir, and the combination. Cell Res. 2022;32(3):322-324.

16. Aslam S, Adler E, Mekeel K, Little SJ. Clinical effectiveness of COVID-19 vaccination in solid organ transplant recipients. Transpl Infect, DiS. 2021;23(5):e13705.

17. Zahradka I, Petr V, Modos I, Magicova M, Dusek L, Viklicky O. Association Between SARS‑CoV- 2 Messenger RNA Vaccines and Lower Infection Rates in Kidney Transplant Recipients : A Registry‑Based Report [published online ahead of print, 2022 May 3]. Ann Intern Med. 2022;M21-2973.

18. Callaghan CJ, Mumford L, Curtis RMK et al. Real‑world Effectiveness of the Pfizer‑BioNTech BNT162b2 and Oxford‑AstraZeneca ChAdOx1-S Vaccines Against SARS‑CoV- 2 in Solid Organ and Islet Transplant Recipients. Transplantation. 2022;106(3):436-446.

19. Bruxvoort KJ, Sy LS, Qian L et al. Effectiveness of mRNA-1273 against delta, mu, and other emerging variants of SARS‑CoV- 2: test negative case‑control study. BMJ. 2021;375:e068848. Published 2021 Dec 15.

20. Andrews N, Stowe J, Kirsebom F et al. Covid-19 Vaccine Effectiveness against the Omicron (B.1. 1. 529) Variant. N Engl J Med. 2022;386(16):1532-1546.