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Guidance on the special care of liver or kidney transplant recipients diagnosed with COVID-19

Due to the COVID-19 pandemic caused by infection with the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant medicine also had to face a new, hitherto unknown challenge. To be prepared for any possibility, we consider it important to summarize the current knowledge regarding COVID-19 of liver and kidney transplant patients. Very early reports from Spanish and French registry recorded fatality rates of 18.6% and 13%, respectively, in renal patients which suggests a moderately worse outcome compared to the general population. In patients with positive PCR test but not showing clinical signs, the reduction of immunosuppression is not advised. In the case of gastrointestinal or respiratory signs with fever, the discontinuation of mycophenolate or mTOR inhibitors is recommended with decrease of the trough levels of calcineurin inhibitors to the lowest effective limit. Stop (kidney transplanted patients) or decrease (liver transplanted patients) immunosuppression and maintain corticosteroids when pulmonal injury develops and consider anti-IL1 and anti-IL6 monoclonal antibody use when hyperinflammatory syndrome is evolving. No proven effective treatment for SARS-CoV-2 exists currently. The use of lopinavir/ritonavir should be avoided because of the severe drug interaction with calcineurin inhibitors. The efficacy and tolerability of hidroxychloroquin remains to be also questionable; enroll patients into clinical trial with remdesivir or favipiravir if available. COVID-19 is characterized by virus-induced endothelial dysfunction, procoagulant state and renin-angiotensin-aldosteron system imbalance. Early thromboprofilaxis combination with low-molecular-weight heparin and low-dose aspirin is strongly recommended with the maintenance of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II-receptor blocker (ARB) therapy when they were prescribed earlier. Orv Hetil. 2020; 161(32): 1310-1321

Year of Publication: 2020
Contained in: Orvosi hetilap Vol. 161, No. 32 (2020), p. 1310-1321
All journal articles: Search for all articles in this journal
Language: Hungarian
Contributors: Remport, Ádám | Author
Gerlei, Zsuzsanna
Cseprekál, Orsolya
Wagner, László
Földes, Katalin
Marton, Adrienn
Patonai, Attila
Török, Szilárd
Haboub-Sandil, Anita
Varga, Marina
Doros, Attila
Smudla, Anikó
Fazakas, János
Kóbori, László
Full text access:
Electronic availability is being checked...
Links: Full Text (dx.doi.org)
Keywords: 2494G1JF75
COVID-19
COVID–19
Journal Article
O3J8G9O825
immunosuppression
immunszuppresszió
liver transplantation
lopinavir-ritonavir drug combination
májátültetés
renal transplantation
veseátültetés
Additional Keywords: *Kidney Transplantation
*Liver Transplantation
*Transplant Recipients
Adrenal Cortex Hormones
Betacoronavirus
Calcineurin Inhibitors
Contraindications, Drug
Coronavirus Infections
Drug Combinations
Drug Interactions
Humans
Immunosuppression
Lopinavir
Pandemics
Pneumonia, Viral
Ritonavir
ISSN: 1788-6120
Note: Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Notes: Date Completed 06.08.2020
Date Revised 06.08.2020
published: Print
Citation Status MEDLINE
Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
PMID:
    32750019
Physical Description: Online-Ressource
ID (e.g. DOI, URN): 10.1556/650.2020.31923
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