scholarly journals Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy

2020 ◽  
Vol 8 (7) ◽  
pp. 977 ◽  
Author(s):  
Lorenzo Cavagna ◽  
Elena Seminari ◽  
Giovanni Zanframundo ◽  
Marilena Gregorini ◽  
Angela Di Matteo ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Calcineurin Inhibitor ◽  
Clinical Course ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Infectious Complications ◽  
Study Data ◽  
Solid Organ ◽  
The North

The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to 28 April 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48–69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.

scholarly journals Recent options in drug therapy after solid organ transplantation

2012 ◽  
Vol 153 (33) ◽  
pp. 1294-1301
Author(s):  
Balázs Pőcze ◽  
Péter Németh ◽  
Róbert Langer
Keyword(s):  
Immune Response ◽  
Organ Transplantation ◽  
Survival Rates ◽  
Solid Organ Transplantation ◽  
Tolerance Induction ◽  
Calcineurin Inhibitors ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Patient And Graft Survival

Solid organ transplantation has shown improvement in patient and graft survival rates due to the development of immunosuppression in the last fifty years; however only the last two decades led to the development of new, baseline immunosuppressive drugs that avoid the unlikely side effects of calcineurin inhibitors, especially nephrotoxicity. The transplanted organ is foreign to the host and, therefore, it induces a complex immune response of the recipient. In this review, a brief outline of immune response is given, followed by the introduction of new immunosuppressive drugs acting via variant pathways. These are compounds which are already in use or becoming shortly available and are potential future alternatives for the calcineurin inhibitors. This paper highlights the role of co-stimulation blockade with belatacept and the recently even more intensively studied field of tolerance induction. Orv. Hetil., 2012, 153, 1294–1301.

scholarly journals Clinical presentation and evolution of COVID-19 in immunosuppressed patients. Preliminary evaluation in a North Italian cohort on calcineurin-inhibitors based therapy

2020 ◽  
Author(s):  
Lorenzo Cavagna ◽  
Raffaele Bruno ◽  
Giovanni Zanframundo ◽  
Marilena Gregorini ◽  
Elena Seminari ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Clinical Course ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Cross Sectional Study ◽  
Phone Call ◽  
Preliminary Evaluation ◽  
Solid Organ ◽  
Cross Sectional ◽  
Immunosuppressed Patients

ABSTRACTThe clinical course of COVID-19 in patients undergoing chronic immunosuppressive therapy is yet poorly known. We performed a monocentric cross-sectional study describing the clinical course of COVID-19 in a cohort of patients from northern Italy treated with calcineurin-inhibitors for organ transplantation or rheumatic diseases. Data were collected by phone call and clinical chart review between March 27th- 31st 2020. COVID-19 related symptoms, rynopharingeal swab, therapeutic changes and outcome were assessed in 384 consecutive patients (57% males; median age 61 years, IQR 48-69). 331 patients (86%) received solid organ transplantation (kidney n=140, 36%, heart n=100, 26%, lung n=91, 24%) and 53 (14%) had a rheumatic disease. Calcineurin inhibitors were the only immunosuppressant administered in 46 patients (12%). 14 patients developed a “confirmed COVID-19” (swab positivity) and 14 a “clinical COVID-19” (only typical symptoms). Fever (75%) and diarrhoea (50%) were the most common symptoms. Fourteen patients were hospitalized and 11 have already been dismissed. No patient required start/changes of the O2 therapy or developed superinfection. Only one patient, with metastatic lung cancer, died. In conclusion, COVID-19 showed a mild course in our cohort, with low mortality. Calcineurin inhibitor-based immunosuppressive regimens appear safe in this context and should not be discontinued.

scholarly journals Calcineurin Inhibitor Toxicity in Solid Organ Transplantation

Pharmacology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Andrea Karolin ◽  
Vera Genitsch ◽  
Daniel Sidler
Keyword(s):  
Organ Transplantation ◽  
Calcineurin Inhibitor ◽  
Clinical Presentation ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Therapeutic Window ◽  
Solid Organ ◽  
Metabolic Disturbances ◽  
Function Impairment

Calcineurin inhibitors (CNIs) have a substantial role in maintaining immunosuppression after solid organ transplantation (SOT). These drugs have a narrow therapeutic window, and individual doses and drug treatment monitoring are necessary. Still, a substantial proportion of patients suffer from short- or long-term calcineurin inhibitor toxicity (CNT), including kidney function impairment, hypertension, neurotoxicity, and metabolic disturbances. The authors discuss pathophysiology, clinical presentation, and histological features of CNT, with focus on renal manifestations. Furthermore, we elucidate recent and ongoing attempts to reduce the burden of CNT in SOT including CNI-sparing and CNI-free regimens.

The role of radiotherapy in patients with solid tumours after solid organ transplantation: a systematic review

2021 ◽  
Vol 22 (3) ◽  
pp. e93-e104
Author(s):  
Rosario Mazzola ◽  
Francesco Cuccia ◽  
Alessandro Bertani ◽  
Slavisa Tubin ◽  
Pier Giulio Conaldi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Tumours ◽  
Solid Organ

Living Organ Donation Role of Ethics for Improved Clinical Practice

2018 ◽  
pp. 242-259
Author(s):  
Pierpaolo Di Cocco
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Financial Incentives ◽  
Ethical Issues ◽  
Supply And Demand ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Live Donor ◽  
Live Donation

Solid organ transplantation represents one of the most important achievements in history of medicine. Over the last decades, the increasing number of transplants has not been of the same extent of the number of patients in the waiting lists. Live donation has been implemented in order to reduce the gap between supply and demand. From an ethical standpoint, the donation process from a live donor seems to violate the traditional first rule of medicine—primum non nocere because inevitably exposes healthy persons to a risk in order to benefit another person. In the chapter will be presented the crucial role of ethics and specific ethical issues in the different forms of live donation, such as financial incentives for living donation, reimbursement in unrelated live donation, minor sibling-to-sibling organ donation. The ethical aspects of live donor organ transplantation are continuously evolving; in order to make this strategy more beneficial and lifesaving, everyone involved in the process should make every possible effort with in mind the best interests of the patients.

scholarly journals Deciphering the role of eosinophils in solid organ transplantation

2019 ◽  
Vol 20 (4) ◽  
pp. 924-930
Author(s):  
Oscar Okwudiri Onyema ◽  
Yizhan Guo ◽  
Atsushi Hata ◽  
Daniel Kreisel ◽  
Andrew E. Gelman ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ
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