Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey
IntroductionCoronavirus disease 2019 (COVID-19) poses an important risk of morbidity and of mortality, in patients after solid organ transplantation. Recommendations have been issued by various transplantation societies at the national and European level to manage the immunosuppressive (IS) regimen...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Transplantation |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frtra.2024.1305152/full |
| _version_ | 1797265489806753792 |
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| author | Amélie Jacq Christelle Auvray Mathieu Blot Belaïd Bouhemad Alice Casenaz Baptiste Lamarthée Mathieu Legendre Jean-Pierre Quenot Gilbert Zanetta Claire Tinel Claire Tinel |
| author_facet | Amélie Jacq Christelle Auvray Mathieu Blot Belaïd Bouhemad Alice Casenaz Baptiste Lamarthée Mathieu Legendre Jean-Pierre Quenot Gilbert Zanetta Claire Tinel Claire Tinel |
| author_sort | Amélie Jacq |
| collection | DOAJ |
| description | IntroductionCoronavirus disease 2019 (COVID-19) poses an important risk of morbidity and of mortality, in patients after solid organ transplantation. Recommendations have been issued by various transplantation societies at the national and European level to manage the immunosuppressive (IS) regimen upon admission to intensive care unit (ICU).MethodThe aim of this study was to evaluate the adequacy of IS regimen minimization strategy in kidney transplant recipients hospitalized in an ICU for severe COVID-19, in relation to the issued recommendations.ResultsThe immunosuppressive therapy was minimized in all patients, with respectively 63% and 59% of the patients meeting the local and european recommendations upon admission. During ICU stay, IS was further tapered leading to 85% (local) and 78% (european) adequacy, relative to the guidelines. The most frequent deviation was the lack of complete withdrawal of mycophenolic acid (22%). Nevertheless, the adequacy/inadequacy status was not associated to the ICU- or one-year-mortality.DiscussionIn this single-center cohort, the only variable associated with a reduction in mortality was vaccination, emphasizing that the key issue is immunization prior to infection, not restoration of immunity during ICU stay. |
| first_indexed | 2024-04-25T00:45:37Z |
| format | Article |
| id | doaj.art-dc15257c6fd44b5ea0c76c9f952d189b |
| institution | Directory Open Access Journal |
| issn | 2813-2440 |
| language | English |
| last_indexed | 2024-04-25T00:45:37Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Transplantation |
| spelling | doaj.art-dc15257c6fd44b5ea0c76c9f952d189b2024-03-12T04:58:20ZengFrontiers Media S.A.Frontiers in Transplantation2813-24402024-03-01310.3389/frtra.2024.13051521305152Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice surveyAmélie Jacq0Christelle Auvray1Mathieu Blot2Belaïd Bouhemad3Alice Casenaz4Baptiste Lamarthée5Mathieu Legendre6Jean-Pierre Quenot7Gilbert Zanetta8Claire Tinel9Claire Tinel10Department of Nephrology and Kidney Transplantation, Dijon University Hospital, Dijon, FranceDepartment of Virology, Dijon University Hospital, Dijon, FranceDepartment of Infectious Diseases, Dijon University Hospital, Dijon, FranceAnesthesia and Intensive Care Department, Dijon University Hospital, Dijon, FranceDepartment of Virology, Dijon University Hospital, Dijon, FranceTAI-IT Department, Inserm UMR Right, Université de Franche Comté, EFS BFC, Besançon, FranceDepartment of Nephrology and Kidney Transplantation, Dijon University Hospital, Dijon, FranceMedical Intensive Care Department, Dijon University Hospital, Dijon, FranceDepartment of Nephrology and Kidney Transplantation, Dijon University Hospital, Dijon, FranceDepartment of Nephrology and Kidney Transplantation, Dijon University Hospital, Dijon, FranceTAI-IT Department, Inserm UMR Right, Université de Franche Comté, EFS BFC, Besançon, FranceIntroductionCoronavirus disease 2019 (COVID-19) poses an important risk of morbidity and of mortality, in patients after solid organ transplantation. Recommendations have been issued by various transplantation societies at the national and European level to manage the immunosuppressive (IS) regimen upon admission to intensive care unit (ICU).MethodThe aim of this study was to evaluate the adequacy of IS regimen minimization strategy in kidney transplant recipients hospitalized in an ICU for severe COVID-19, in relation to the issued recommendations.ResultsThe immunosuppressive therapy was minimized in all patients, with respectively 63% and 59% of the patients meeting the local and european recommendations upon admission. During ICU stay, IS was further tapered leading to 85% (local) and 78% (european) adequacy, relative to the guidelines. The most frequent deviation was the lack of complete withdrawal of mycophenolic acid (22%). Nevertheless, the adequacy/inadequacy status was not associated to the ICU- or one-year-mortality.DiscussionIn this single-center cohort, the only variable associated with a reduction in mortality was vaccination, emphasizing that the key issue is immunization prior to infection, not restoration of immunity during ICU stay.https://www.frontiersin.org/articles/10.3389/frtra.2024.1305152/fullkidney transplant recipientsCOVID-19medical practices surveyvaccinationintensive care unit |
| spellingShingle | Amélie Jacq Christelle Auvray Mathieu Blot Belaïd Bouhemad Alice Casenaz Baptiste Lamarthée Mathieu Legendre Jean-Pierre Quenot Gilbert Zanetta Claire Tinel Claire Tinel Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey Frontiers in Transplantation kidney transplant recipients COVID-19 medical practices survey vaccination intensive care unit |
| title | Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey |
| title_full | Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey |
| title_fullStr | Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey |
| title_full_unstemmed | Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey |
| title_short | Adequacy to immunosuppression management guidelines in kidney transplant recipients with severe COVID-19 pneumonia: a practice survey |
| title_sort | adequacy to immunosuppression management guidelines in kidney transplant recipients with severe covid 19 pneumonia a practice survey |
| topic | kidney transplant recipients COVID-19 medical practices survey vaccination intensive care unit |
| url | https://www.frontiersin.org/articles/10.3389/frtra.2024.1305152/full |
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