La pandemia del nuovo coronavirus 2019 ed il trapianto renale

  • Aris Tsalouchos Azienda Usl Toscana Centro, S.O.S. Nefrologia e Dialisi, Ospedale SS Cosma e Damiano, Pescia, Pistoia - Italia
  • Maurizio Salvadori Professore di Nefrologia, già Direttore Nefrologia e Trapianto, Azienda Ospedaliera Careggi, Firenze - Italia
Parole chiave: Coronavirus, Pandemic, Renal transplantation, Covid-19

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major pandemic challenging health care. Infection has been reported in all ages, but older patients and immunosuppressant patients as the transplanted are at major risk. Prevention and treatment, whenever possible are the commonly used strategies. Three steps may be distinguished. In the first step prophylaxis is essential and based in avoiding any possible contact to infected people. Staying at home, masking the patient, carefully washing the hands are the most commonly used strategies. If the disease develops in  a transplanted patient two steps must be added. In the first step the reduction of the immunosuppressive therapy must be considered together with the administration of antiviral drugs. In a second phase of the disease a severe lung involvement may develop mostly due to a inflammation citokine induced. In this phase in addition to a intensive ventilation requiring the intensive care unit, anticytokine drugs as tocilizumab should be considered. 

Riferimenti bibliografici

Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb 7. [Epub ahead of print]

World Health Organization Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Available at: https://who.int/csr/sars/country//table2004_04_21/en/. Accessed January 27, 2020.

World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). November 2019. Available at: http://www/who.int/emergencies/mers-cov/en/. Accessed February 27, 2020.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.

Center for Disease Control and Prevention. Frequently asked questions and answers: Coronavirus Disease-2019 (COVID-19) and children. Available at: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/children-faq.html. Accessed March 2, 2020.

ERACODA Study Report. The ERA-EDTA COVID-19 Database for Patients on Kidney Replacement Therapy. Available at: https://www.era-edta.org/en/wp-content/uploads/2020/04/ERACODA-Study-Report-2020-04-07. Accessed April 8, 2020.

Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med. 2020 Mar 20. [Epub ahead of print]

Michaels MG, La Hoz RM, Danziger-Isakov L, et al. Coronavirus disease 2019: Implications of emerging infections for transplantation. Am J Transplant. 2020 Feb 24. [Epub ahead of print]

Centre for Disease Control. Follow updated guidelines. https://www.cdc.gov/coronavirus/2019-ncov/infection-control.html. Accessed April 8, 2020.

Alberici F, Delbarba E, Manenti C, et al. Management Of Patients On Dialysis And With Kidney Transplant During SARS-CoV-2 (COVID-19) Pandemic In Brescia, Italy. Kidney Int Rep. 2020 Apr 4. [Epub ahead of print]

ERA-EDTA WG Descartes expert opinion regarding the management of immunosuppressive medication for kidney transplant patients during the COVID-pandemic. Available at https://www.era-edta.org/en/wp-content/uploads/2020/04/Expert-opinion-on-ISD-in-Covid-19. Accessed April 8, 2020.

Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020 Mar 10. [Epub ahead of print]

Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar 20 [Epub ahead of print]

Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun. 2020;11(1):222-36.

de Wit E, Feldmann F, Cronin J, et al. Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection. Proc Natl Acad Sci U S A. 2020;117(12):6771-6.

Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71.

Frey N, Porter D. Cytokine Release Syndrome with Chimeric Antigen Receptor T Cell Therapy. Biol Blood Marrow Transplant. 2019;25(4):e123-7.

Pachetti M, Marini B, Benedetti F, et al. Emerging SARS-CoV-2 mutation hot spots include a novel RNA-dependent-RNA polymerase variant. Translational Medicine. In press

American Society of Transplantation. 2019-nCoV (Coronavirus): FAQs for Organ Donation and Transplantation. Updated March 30, 2020. Available at: https://optn.transplant.hrsa.gov/news/information-fortransplant-programs-and-opos-regarding-2019-novel-coronavirus/. Accessed April 8, 2020.

Pubblicato
2020-05-06
Sezione
Review

##plugins.generic.recommendByAuthor.heading##