Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2?

Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with COVID-19. However, outcomes remain poor. Given the likely benefit of cyclosporine due to its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with SARS-CoV-2. We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID-19 between March,15- April, 24th , 2020. Mycophenolate and/or mTORi were discontinued in all patients. Two therapeutic strategies were compared: Group 1) minimization of calcineurin inhibitors (N=6); Group 2) cyclosporine-based therapy (N=23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after a respiratory distress (20.6%). Five required mechanical ventilation (17.2 %), and three could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3/6 patients died (50%) and 1/6 required invasive mechanical ventilation (IVM) (16.7%). In group 2, three patients died 3/23 (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID-19.