Abstract
There are emerging data depicting the clinical presentation of coronavirus disease 19 (COVID-19) in solid organ transplant recipients but negligible data-driven guidance on clinical management. A biphasic course has been described in some infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), beginning with a flu-like illness followed by an intense inflammatory response characterized by elevated c-reactive protein (CRP), interleukin 6 (IL-6), and acute respiratory distress syndrome (ARDS) associated with high mortality. The exuberant and possibly dysregulated immune response has prompted interest in therapeutic agents that target the cytokines involved, particularly IL-6. Tocilizumab is an IL-6 receptor antagonist with a record of use for a variety of rheumatologic conditions and cytokine release syndrome due to chimeric antigen receptor T-cell therapy but experience in solid organ and composite tissue transplant recipients (SOT/CTTRs) with SARS-CoV-2-related ARDS has not been previously reported in detail. We present the clinical course of 5 SOT/CTTRs with SARS-CoV-2-related ARDS that received tocilizumab with favorable short-term outcomes in 4. Responses were characterized by reductions in CRP, discontinuation of vasopressors, improved oxygenation and respiratory mechanics, and variable duration of ventilator support. Four bacterial infections occurred within 2 weeks of tocilizumab administration. We discuss safety concerns and the need for randomized comparative trials to delineate tocilizumab’s clinical utility in this population.
Keywords: clinical research/practice; infection and infectious agents – viral; infectious disease; off-label drug use.
【저자키워드】 Infectious disease, clinical research/practice, infection and infectious agents - viral, off-label drug use., 【초록키워드】 COVID-19, coronavirus disease, SARS-CoV-2, ARDS, coronavirus, therapy, Trial, Tocilizumab, IL-6, Infection, CRP, cytokine, outcome, Cytokine release syndrome, Randomized, Protein, Clinical course, response, Bacterial infection, Clinical management, therapeutic agent, T-cell, Guidance, chimeric antigen receptor, solid organ transplant, acute respiratory distress, Inflammatory response, Oxygenation, Respiratory mechanics, IL-6 receptor, infectious agent, Support, acute respiratory syndrome, ventilator, tissue, syndrome, high mortality, clinical utility, vasopressors, tocilizumab administration, dysregulated immune response, off-label, recipient, organ, data-driven, Course, described, occurred, involved, reported, elevated, characterized, condition, variety, reductions in, 【제목키워드】 SARS-CoV-2, ARDS, therapy, tissue, recipient,