A review of the evidence for and against the use of steroids in renal transplant patients with COVID-19

Nouf E. AL-Otaibi

doi:10.15537/smj.2021.42.10.20210551

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Table 1

- Cases of kidney transplantation patients infected with Corona virus-19 on steroidal therapy

Type of study/Ref	Age (y)	N	G	Time from transplantation (y)	Maintenance IS	Continued steroid?	Setting	Outcomes
Cohort trial⁵	51-64	20	M, F	Median 13	Withdrawn all IS started on methylpred 16 mg	Yes	6 mild hospitalized 10 severe, 4 critical (ICU)	6 patients developed AKI 5 patients died
Case report¹³	65	1	M	Unknown	TAC, MMF, Pred	Yes	Severe ICU	Recovery after 10 days
Case series¹⁴	21	8	F	0.3	TAC, Pred	Yes	Inpatient	Recovery Discharged after 2 days
	71		M	3	TAC, Pred	Yes	Inpatient	Discharged after 2 days with stable kidney function
	50		M	0.2	TAC reduced dose, Pred	Yes	Self-isolation	Full recovery
	63		M	15	TAC, Pred	Yes	Inpatient	Recovery discharged after 7 days
	47		F	0.4	TAC, Pred	Yes	Severe ICU	AKI recovery, discharged after 21 days
	71		F	15	TAC, Pred	Yes	Inpatient	Discharged after 4 days with full recovery
	40		F	3
	38		M	6	TAC reduced dose, Pred	Yes		Discharged after 2 days
Systematic review¹⁵	31-75	554	M, F	Range: 0-25	CNI: withdrawn in 31.9%, reduced in 19.7% AD: withdrawn in 75.3%, reduced in 9.5% 72% were on Pred	Yes	Ranging from home isolation to ICU admission	Renal graft function remained stable in 76.17% of patients, whereas 8.84% experienced graft loss and 1.44% developed AKI. 21.84% of patients died
Case report¹⁶	29	1	M	1.2	Cyclosporin, MMF, methylpred	Yes	Inpatient	Recovery after 13 days
Case report¹⁷	61	1	F	16	MMF, Pred	Yes	Inpatient	Recovery after 5 days
Case report¹⁸	52	1	M	12	D/C all IS. Started on methylpred 40 mg	Yes	Inpatient	Recovery discharge after 13 days
Case report¹⁹	50	1	M	4	Pred continued TAC and everolimus withdrawn	Yes	ICU	Still in ICU at time of report
Case report²⁰	75	2	M	10	TAC, MMF: D/C Pred	Yes	Severe inpatient	Died after 5 days
Case report²⁰	52		F	0.8				AKI discharge on day 14
Case report²¹	58	1	M	11	MMF and steroid	Yes	Severe ICU	Died with multiorgan dysfunction
Case report²²	32	1	M	2	MMF, increased dose Pred, TAC	Yes	Inpatient	AKI resolution and discharge
Case report²³	28	1	F	0.5	MMF, TAC, Pred	Yes	Mild inpatient	Discharged with full recovery
Case report²⁴	54	1	M	5	DC TAC, Pred, EVE, continued on methypred 40 mg IV daily	Yes	Severe ICU	Discharged after 49 days
Systematic review²⁵	21-80	561	M, F	0-31	Outcome n=144: 84 patients increase steroid dose, 6 patients either reduced or DC, 45 patients with no change	Variable	73 severe inpatients 40 ICU	Outcome reported for 144 patients: 74 patients discharged 36 improved still in hospital, 34 died
Cohort study²⁶	53.8 ±13.5	38	M, F	Median 5.8	84.2% on TAC, 89.5% on MMF, 81.6% on Pred. Adjunct steroid boluses were provided for ARDS	Yes	38 hospitalized: 20 severe ICU	27 patients survived 11 patients died

Ref: reference, N: number of patients, G: gender, M: male, F: female, IS: immunosuppression, ICU: intensive care unit, MMF: mycophenolate mofetil, TAC: Tacrolimus, Pred: prednisolone, CNI: calcineurin inhibitors either tacrolimus or cyclosporin, AD: antimetabolite drugs including mycophenolate and azathioprine, AKI: acute kidney injury, D/C: Discontinued, methylpred: methylprednisolone, EVE: everolimus, ARDS: acute respiratory distress syndrome, IV: intravenous