EARLY REMDESIVIR FOR VACCINATED KIDNEY TRANSPLANT RECIPIENTS WITH MILD-MODERATE COVID-19 INFECTION
Daniel Hirsch1, Vithoo Sivanathan1, Eleanor Agnew1, Abidev Kuhasri1, Vivian Lee2, Stella McGinn1, Yan Li1 1Department of Nephrology, Royal North Shore Hospital, Sydney, NSW, Australia2Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
Abstract
Aim: To assess the safety and efficacy of early Remdesivir in kidney transplant recipients with mild-moderate COVID-19 infection.
Background: Remdesivir inhibits the COVID-19 RNA dependent RNA polymerase. In Australia, early Remdesivir is increasingly administered to kidney transplant recipients (KTRs) with mild-moderate COVID-19 infection in the hope of attenuating disease progression. It’s safety and efficacy are unclear.
Methods: We performed a retrospective cohort study of all KTRs infected with COVID-19 between April-October 2022 at our centre. Eligible patients were offered a 3-dose course of intravenous Remdesivir within five-days of illness. Bloods were collected at each administration. Electronic medical records were reviewed retrospectively, and all patients were invited to complete an online questionnaire at 3-months post infection.
Results: Of 79 participants, 60 received Remdesivir and 19 did not. There were no differences in demographics between groups. All but one patient in the Remdesivir group was fully vaccinated (>2 doses). There were numerically fewer COVID-19 specific hospitalisations at 30-days in the Remdesivir group (7% vs. 11%, p=0.58), although not significant. There was no difference in oxygen requirement (3% vs 11%, p= 0.21), intubation (2% vs. 0%, p=0.57), ICU admission (3% vs. 11%, p=0.21) or 30-day mortality (0% vs. 0%, p=1) between groups. In patients receiving Remdesivir, rates of AKI and mild transaminitis were 0% and 3%, respectively. At a median follow-up of over three months, patients who did not receive Remdesivir were more likely to report ongoing dyspnoea, headache, and poor concentration.
Conclusions: Early Remdesivir use was not associated with significant improvement in disease severity compared to no treatment among vaccinated KTRs. Remdesivir was safe and associated with fewer reported symptoms at three months.
Biography
Daniel Hirsch is an advanced trainee in nephrology based in NSW, Australia. His interests include medical education and doctor wellbeing. He currently works in Tamworth, rural NSW.