Francesco Scolari

Nephrology and Covid-19: risk factors for kidney transplant recipients. In the study of the University of Brescia, the largest cohort of patients described so far

Brescia research published in the American Journal of Transplantation.

Mortality greater than 25% of patients.

Immunosuppressive therapy modified during SARS-CoV2 infection.

Brescia, 21 August 2020 – In a study coordinated by the Nephrology of the University of Brescia, directed by prof. Francesco Scolari, the risk factors of unfavorable evolution in kidney transplant patients affected by Covid 19 have been identified.

The study, published in the prestigious American Journal of Transplantation, describes the largest cohort of patients present in the literature to date.

In our cohort, we observed a great variability in terms of severity of the disease, from a flu-like form to a severe form with a poor prognosis, with mortality exceeding 25% of patients – explains prof. Scolari, Associate Professor of Nephrology at the University of Brescia and Director of the Nephrology Division of the ASST Spedali Civili of Brescia -. Severe lymphopenia and thrombocytopenia were associated with poor disease prognosis. Our choice was to discontinue major immunosuppressive drugs while simultaneously increasing cortisone doses. In fact, the preliminary analysis of our results showed that therapy with Tacrolimus, the most potent immunosuppressive drug, seemed to be associated with higher mortality. However, these data must be interpreted with great caution and need to be confirmed in larger series ».

The Brescia Nephrology Unit is the largest in the country with about 500 dialysis patients and over 1,200 transplant patients. Converted into a Covid-19 ward, in order to accommodate transplanted and dialysed patients affected by Covid-19, the Nephrology Operating Unit has developed a patient management protocol, published in the Kidney International Reports, official journal of the International Society of Nephrology , and in the Italian Journal of Nephrology, as well as having been shared and adopted by Columbia University in New York.

«Our experience in the management of renal transplant patients hospitalized at the Nephrology of Brescia for Covid-19 pneumonia – continues prof. Scolari – mshowed that transplant patients have a high risk of progression of SARS-CoV2 infection, with worse prognosis than the general population. Already from the first observations important information emerged regarding the clinical management of these patients; in particular, social isolation, a pivotal point for containing the infection in the general population, is of further importance in this population; in addition, kidney transplant carriers affected by Covid-19, in case of pneumonia, always need to be hospitalized to ensure close monitoring ».

For these reasons – concludes prof. Scolari – and due to the increased risk compared to the general population in the presence of a particularly severe SARS-CoV2 pandemic event, we decided to temporarily suspend the kidney transplant program in the center of Brescia, which was reopened in July “.

The study collaborated with prof. Federico Alberici, Associate Professor of Nephrology at the University of Brescia and dr. Nicola Bossini, head of the Kidney Transplant Section.

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