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Title: Case Report: Successful Response to Intravenous Immunoglobulin and Steroid Pulses in a Renal Transplant Recipient With Severe Covid-19 Disease and Associated Acute Allograft Failure.
Authors: Rosa-Guerrero, Pedro
Trujillo-Aguilera, Antonio
Molina, Juan
Navas, Ana
López-Martín, Cristina
Jurado, Aurora
Rodríguez-Benot, Alberto
Torres-De-Rueda, Álvaro
Keywords: Covid-19;SARS-CoV-2;case report;cytokine storm;intravenous immunoglobulin;kidney transplantation;steroids
metadata.dc.subject.mesh: Acute Disease
Anti-Inflammatory Agents
Disease Progression
Graft Rejection
Immunoglobulins, Intravenous
Immunosuppressive Agents
Kidney Failure, Chronic
Kidney Transplantation
Middle Aged
Renal Dialysis
Respiration, Artificial
Transplant Recipients
Transplantation, Homologous
COVID-19 Drug Treatment
Issue Date: 11-May-2021
Abstract: The impact of Covid-19 pneumonia caused by SARS-CoV-2 on transplanted populations under chronic immunosuppression seems to be greater than in normal population. Clinical management of the disease, particularly in those patients worsening after a cytokine storm, with or without allograft impairment and using available therapeutic approaches in the absence of specific drugs to fight against the virus, involves a major challenge for physicians. We herein provide evidence of the usefulness of high-dose intravenous immunoglobulin (IVIG) combined with steroid pulses to successfully treat a case of Covid-19 pneumonia in a single-kidney transplanted patient with mechanical ventilation and hemodialysis requirements in the setting of a cytokine storm. A rapid decrease in the serum level of inflammatory cytokines, particularly IL-6, IL-8, TNF-α, MCP-1 and IL-10, as well as of acute-phase reactants such as ferritin, D-dimer and C-reactive protein was observed after the IVIG infusion and methylprednisolone bolus administration with a parallel clinical improvement and progressive allograft function recovery, allowing the patient's final discharge 40 days after the treatment onset. The immunomodulatory effect of IVIG together with the anti-inflammatory and immunosuppressive potential of steroids could be an alternative strategy to treat severe cases of Covid-19 pneumonia associated with an uncontrolled inflammatory response in transplanted populations.
metadata.dc.identifier.doi: 10.3389/fimmu.2021.671013
Appears in Collections:Producción 2020

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