key: cord-0858024-45jm525i
authors: Montagud‐Marrahi, Enrique; Cofan, Frederic; Torregrosa, Josep‐Vicens; Cucchiari, David; Ventura‐Aguiar, Pedro; Revuelta, Ignacio; Bodro, Marta; Piñeiro, Gaston J.; Esforzado, Nuria; Ugalde, Jessica; Guillén, Elena; Rodríguez‐Espinosa, Diana; Campistol, Josep M.; Oppenheimer, Federico; Moreno, Asunción; Diekmann, Fritz
title: Preliminary data on outcomes of SARS‐CoV‐2 infection in a Spanish single center cohort of kidney recipients
date: 2020-05-27
journal: Am J Transplant
DOI: 10.1111/ajt.15970
sha: cefa36cddbe62fbea49267d265d274b767f29443
doc_id: 858024
cord_uid: 45jm525i

Since the first cases of Coronavirus Disease 2019(COVID-19) were identified on December 12th , 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has dramatically spread worldwide becoming a pandemic with devastating consequences1 . This exponential increase in COVID-19 cases also includes vulnerable populations such as kidney recipients2,3 . Although scarce, preliminary information in this population suggests a serious course with a mortality of up to 25%4 . Herein, we report the outcomes of a cohort of 33 kidney transplant recipients from a single center focusing on hospital and intensive care (ICU) admission and mortality.

To the Editor:

Since the first cases of coronavirus disease 2019(COVID-19) were identified on December 12, 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has dramatically spread worldwide becoming a pandemic with devastating consequences. 1 This exponential increase in COVID-19 cases also includes vulnerable populations such as kidney recipients. 2, 3 Although scarce, preliminary information in this population suggests a serious course with a mortality of up to 25%. 4 Herein, we report the outcomes of a cohort of 33 kidney transplant recipients from a single center focusing on hospital and intensive care (ICU) admission and mortality.

Our center has performed an average of 145 isolated and combined kidney transplants per year over the last 10 years. Since According to our protocol, 14% and 29% of the outpatients were treated with an azithromycin and hydroxychloroquine combination and azithromycin monotherapy, respectively. Of the inpatients, 80.8% were treated with a lopinavir/ritonavir, azithromycin, and hydroxychloroquine combination; 3.8% with an azithromycin and hydroxychloroquine combination; 7.7% with hydroxychloroquine; and 3.8% with azithromycin monotherapy. In addition, 73% of the inpatients required COVID-19 treatment intensification (50% tocilizumab, 7.7% interferon beta, 50% steroid pulses, 11.5% anakinra). Our policy is to temporarily discontinue immunosuppressants in admitted patients (mycophenolate and/or mTOR inhibitors in all patients, and CNI if lopinavir/ritonavir is prescribed due to interactions). Maintenance immunosuppression is based on prednisone were not subjected to any specific cardiological follow-up during treatment, because the risk of arrhythmic events associated with short-term treatment with hydroxychloroquine (without lopinavir/ ritonavir) was assumed to be low.

The current average ICU stay is of 11 ± 7.2 days. Two patients (an 87-year-old woman and a 72-year-old man) (6%) died after 13 and 22 days from admission, respectively, although there still are 2 patients in the ICU (with noninvasive mechanical ventilation). Another graft was lost in a patient with chronic graft dysfunction. Twentyone patients (81%) were discharged after 12.2 ± 7.1 days from admission. To reduce hospital pressure, our center has enabled a medicalized hotel for early hospital discharges of patients with a favorable course. With this system, 10 patients (38%) were discharged to the adapted hotel (mean hotel stay of 7.7 ± 2.7 days).

With this letter we would like to provide preliminary information about a single center kidney transplant population in Spain.

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