key: cord-275238-5fledjac
authors: Gandolfini, Ilaria; Delsante, Marco; Fiaccadori, Enrico; Zaza, Gianluigi; Manenti, Lucio; Degli Antoni, Anna; Peruzzi, Licia; Riella, Leonardo V.; Cravedi, Paolo; Maggiore, Umberto
title: COVID‐19 in kidney transplant recipients
date: 2020-04-12
journal: Am J Transplant
DOI: 10.1111/ajt.15891
sha: 
doc_id: 275238
cord_uid: 5fledjac

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly and has already taken on pandemic proportions. After China, Italy is the country with the highest number of cases so far (41,035 confirmed cases according to Dipartimento della Protezione Civile as of March 19, and 3,405 deaths). In Northern Italy, where the current prevalence of confirmed cases has surpassed in some areas 2 per 1,000 people, kidney transplant patients are getting infected and starting to develop coronavirus disease 2019 (COVID-19).

To the Editor:

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly and has already taken on pandemic proportions. 1 There are only limited data on COVID-19 in transplant recipients. 2 Herein, we report the outcomes of two deceased-donor kidney transplant recipients with COVID-19 pneumonia admitted to the Hospital of Parma (Parma, Italy), between March 2 and 12, 2020.

One was a 75-year-old male (patient 1) and the other a 52-year-old female (patient 2), at 120 and 8 months after transplant, respectively (Table 1) . Symptoms (cough, myalgia, and fever 38-39°C) started 3 and 1 days before admission for patients 1 and 2, respectively. At In kidney transplant recipients with COVID-19 who develop extensive pneumonia, which may require intubation, our current therapeutic approach includes stopping the immunosuppressive therapy (using steroids as the only antirejection drugs) to help promote the specific anti-viral immune response.

As the cytokine storm triggered by the coronavirus seems to be particularly responsible for morbidity of COVID-19, withdrawal of antirejection therapy can be associated with exacerbation of inflammatory response to viral infection. Therefore, IL-6 targeting therapies are being proposed to control acute respiratory distress syndrome (ARDS; currently being tested in a randomized trial in China; ChiCTR2000029765). A randomized controlled trial is testing the safety/efficacy of steroids (NCT04273321), but until results are available, broad use of steroids is discouraged. 3 Viroporin E, a component of SARS-CoV, forms Ca2C-permeable ion channels and activates the NLRP3 inflammasome. 4 Colchicine prevents NLRP3 inflammasome assembly, thereby reducing the release of IL-1b and other interleukins, including IL-6. 5 In patient 2, colchicine therapy was associated with a fast decrease of IL6 

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