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Background and Aims Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases. Method We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir. Results A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75–68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5–135.5) months, with median glomerular filtration at admission of 47.5 (42.25–63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10–18) days. Conclusion KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.

Background and Aims Mycophenolic acid (MPA) is one of the most used immunosuppressive drugs. It is teratogenic in women with a typical embryopathy profile. Regarding its effect on the children of male kidney transplant recipients, although clinical evidence does not indicate a greater risk of malformations, the European Medicines Agency and the Spanish Agency for Medicines and Health Products introduced in 2015 the recommendation to use contraceptive methods because of their genotoxic potential. For this reason, we propose to study the results of the Spanish Kidney Transplant Centers. Method Multicenter retrospective observational study in which 15 Kidney Transplant Centers have participated. Of 3934 men ≤ 60 years old that received a kidney transplant between 2000 and 2015, 3023 were contacted, and 159 men who fathered at least one post-transplant pregnancy (total 252 fetuses) were included. We compared the incidence of abortions and live births with malformations among those who received MPA at the time of conception vs. those who did not. Results In the 252 fetuses (characteristics in table 1) there was an exitus and no differences were detected in the incidence of abortions between the group exposed to MPA (n = 230) and the unexposed group (n = 22), 11.3% vs 18.2%, p = 0.31. Among the 221 live-born fetuses, no differences were found in congenital malformations between the group exposed to MPA (n = 203) and the unexposed (n = 18) 4.9% vs. 16.7%, p = 0.07. Among the malformations described, the typical embryopathy profile of the MPA was not found. Conclusion According to the data of this retrospective national multicenter study, the use of MPA in male kidney transplant recipients does not cause a greater number of abortions or congenital malformations. For these reasons, and given the evidence also published by other groups, it seems necessary to reevaluate the recommendation given on contraception in men treated with MPA.