Virol J . Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand?

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Virol J


. 2021 Nov 22;18(1):228.
doi: 10.1186/s12985-021-01700-2.
Evaluation of the therapeutic regimen in COVID-19 in transplant patients: where do immunomodulatory and antivirals stand?


Mojtaba Shafiekhani ^{1 2 3} , Farbod Shahabinezhad ³ , Tahmoores Niknam ² , Seyed Ahmad Tara ² , Elham Haem ⁴ , Parviz Mardani ^{5 6} , Zahra Zare ² , Sedigheh Jafarian ² , Khatereh Mirzad Jahromi ² , Sara Arabsheybani ² , Yalda Sadat Moeini ² , Jalile Alavi ² , Seyed Soroush Jalali ³ , Maryam Salimi ⁷ , Reza Shahriarirad ⁸ , Seyed Ali Malekhosseini ²



Affiliations

• PMID: 34809657
• DOI: 10.1186/s12985-021-01700-2

Abstract

Background: The management of COVID-19 in organ transplant recipients is among the most imperative, yet less discussed, issues based on their immunocompromised status along with their vast post-transplant medication regimens. No conclusive study has been published to evaluate proper anti-viral and immunomodulator medications effect in treating COVID-19 patients to this date.
Method: This retrospective study was conducted in Shiraz Transplant Hospital, Iran from March 2020 to May 2021 and included COVID-19 diagnosed patients based on SARS-CoV-2 RT-PCR positive test who had been hospitalized for at least 48 h before enrolling in the study. Clinical and demographic information of patients, along with their treatment course and the medication used were evaluated and analyzed using multiple regression analysis.
Results: A total of 245 patients with a mean age of 49.59 years were included with a mortality rate of 8.16%. The administration of Remdesivir as an anti-viral drug (P value < 0.001) and Tocilizumab as an immunomodulator drug (P value < 0.001) could reduce the hospitalization period in the hospital and the intensive care unit, as well as the mortality rates significantly. Meanwhile, the patients treated with Lopinavir/Ritonavir experienced a lower chance of survival (OR < 1, P value = 0.04). No significant difference was observed between various therapeutic regimens in clinical complications such as bacterial coinfections, cardiovascular and gastrointestinal adverse reactions, and liver or kidney dysfunctions.
Conclusion: The administration of Remdesivir as an anti-viral and Tocilizumab as an immunomodulatory drug in solid-organ transplant recipients could be promising treatments of choice to manage COVID-19.

Keywords: COVID-19; Coronavirus disease 2019; Remdesivir; Tocilizumab; Transplant.