The effectiveness of nirmatrelvir/ritonavir regimen in hospitalized renal transplant patients with prolonged COVID-19 infection: a multicenter clinical experience
Huanxi Zhang,
Wenrui Wu,
Yitao Zheng,
Qian Fu,
Peisong Chen,
Jianyi Li,
Zixuan Wu,
Jincui Gu,
Jun Li,
Longshan Liu,
Chenglin Wu,
Sizhe Long,
Bowen Xu,
Liuting Ling,
Yingxin Fu,
Changxi Wang
Affiliations
Huanxi Zhang
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Wenrui Wu
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Yitao Zheng
Kidney Transplant Department, Organ Transplant Center, Third People’s Hospital of Shenzhen, The Second Affiliated Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen, China
Qian Fu
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Peisong Chen
Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Jianyi Li
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Zixuan Wu
Kidney Transplant Department, Organ Transplant Center, Third People’s Hospital of Shenzhen, The Second Affiliated Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen, China
Jincui Gu
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Jun Li
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Longshan Liu
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Chenglin Wu
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Sizhe Long
Center for Information Technology and Statistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Bowen Xu
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Liuting Ling
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Yingxin Fu
Kidney Transplant Department, Organ Transplant Center, Third People’s Hospital of Shenzhen, The Second Affiliated Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen, China
Changxi Wang
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Objectives Effectiveness of nirmatrelvir/ritonavir (NR) in kidney transplant recipients (KTRs) infected COVID-19 for more than 5 days has not been evaluated.Methods In this multicenter retrospective study, 85 KTRs with COVID-19 were enrolled, including 50 moderate, 21 severe, and 14 critical patients.Results The median time from onset to starting NR treatment was 14 (IQR, 11–19) days. Before NR treatment, 96.5% patients reduced use of antimetabolites. They also stopped using calcineurin inhibitors (CNI) 12–24 hours before NR treatment, with CNI concentrations well-controlled during NR treatment. The use of intravenous corticosteroids increased with COVID-19 severity. The median time to reach viral negative conversion was 5 (IQR, 4–8) days for all patients. For moderate and severe COVID-19 patients, they had a low rate of ICU admission (1.4%), exacerbation requiring upgraded oxygen therapy (5.6%), and dialysis (2.8%); no intubation and mechanical ventilation, and no deaths were observed. Patients with critical COVID-19 had a low mortality rate (7.1%).Conclusions A regimen including NR for clearing SARS-CoV-2 along with reducing immunosuppressants and using intravenous corticosteroids is associated with lower rates of exacerbation and mortality in KTRs who have moderate to critical SARS-CoV-2 infection and the virus still present after 5 days.
