• María J Pérez-Sáez, Miquel Blasco, Dolores Redondo-Pachón, Pedro Ventura-Aguiar, Teresa Bada-Bosch, Isabel Pérez-Flores, Edoardo Melilli, Luis A Sánchez-Cámara, María O López-Oliva, Cristina Canal, Amir Shabaka, Núria Garra-Moncau, Paloma L Martín-Moreno, Verónica López, Román Hernández-Gallego, Orlando Siverio, Cristina Galeano, Jordi Espí-Reig, Carlos J Cabezas, María T Rodrigo, Laura Llinàs-Mallol, María J Fernández-Reyes, Leónidas Cruzado-Vega, Lourdes Pérez-Tamajón, Raquel Santana-Estupiñán, María C Ruiz-Fuentes, Guadalupe Tabernero, Sofía Zárraga, Juan C Ruiz, Alex Gutiérrez-Dalmau, Auxiliadora Mazuecos, Emilio Sánchez-Álvarez, Marta Crespo, Julio Pascual, and Spanish Society of Nephrology COVID-19 Group.
• Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain.
• Am. J. Transplant. 2020 Nov 1; 20 (11): 3182-3190.

AbstractAcute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.

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