vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2023-1-7-14vtio-1563Research ArticleКлиническая трансплантологияClinical TransplantologyОпыт применения нейтрализующих моноклональных антител у реципиентов почечного трансплантата с СOVID-19Experience in the use of neutralizing monoclonal antibodies in kidney transplant recipients with COVID-19КимИ. Г.KimI. G.

Ким Ирина Гиховна - ведущий научный сотрудник Московского НИИ эпидемиологии и микробиологии им. Г.Н.Габричевского ; врач-нефролог консультативно-диагностического нефрологического отделения ГКБ № 52. 

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Марьяна Анатольевна Лысенко - главный врач ГКБ №52, профессор кафедры общей терапии факультета дополнительного профессионального образования РНИМУ им. Н.И. Пирогова. 

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Надия Фяатовна Фролова - заместитель главного врача по нефрологической помощи  ГКБ№52; доцент кафедры нефрологии факультета дополнительного профессионального образования МГМСУ им. А.И. Евдокимова.

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Алина Михайловна Никитина - врач-нефролог нефрологического отделения ГКБ № 52.

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Nikitia.A.M.l@gmail.comВиноградовВ. Е.VinogradovV. E.

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Елизавета Владимировна Володина - научный сотрудник клинико-диагностического отдела МНИИЭМ им. Г.Н. Габричевского.

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vol.e.v@yandex.ruЧервинкоВ. И.ChervinkoV. I.

Валерий Иванович Червинко - ведущий научный сотрудник клинико-диагностического отдела МНИИЭМ им. Г.Н. Габричевского; преподаватель кафедры терапии неотложных состояний филиала Военно-медицинской академии им. С.М.Кирова; врач-нефролог консультативно-диагностического нефрологического отделения ГКБ № 52.

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dok534@yandex.ruКрюковЕ. В.KryukovE. V.

Евгений Владимирович Крюков - начальник Военно-медицинской академии им. С.М. Кирова.

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evgeniy.md@mail.ruЗубкинМ. Л.ZubkinM. L.

Михаил Леонидович Зубкин - руководитель клинико-диагностического отдела МНИИЭМ им. Г.Н. Габричевского, профессор кафедры терапии неотложных состояний филиала Военно-медицинской академии им. С.М.Кирова в г. Москве; консультант консультативно-диагностического нефрологического отделения  ГКБ № 52.

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m-zubkin@yandex.ruФБУН Московский научно-исследовательский институт эпидемиологии и микробиологии имени Г.Н. Габричевского Роспотребнадзора; ГБУЗ города Москвы Городская клиническая больница № 52, Департамент здравоохранения г. МосквыРоссияGabrichevsky Moscow Research Institute of Epidemiology and Microbiology; Pirogov Russian National Research Medical UniversityRussian FederationГБУЗ города Москвы Городская клиническая больница № 52, Департамент здравоохранения г. Москвы; ФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова, Минздрав РоссииРоссияPirogov Russian National Research Medical University; Pirogov Russian National Research Medical UniversityRussian FederationГБУЗ города Москвы Городская клиническая больница № 52, Департамент здравоохранения г. Москвы; ФГБОУ ВО Московский государственный медико-стоматологический университет имени А.И. Евдокимова, Минздрава РоссииРоссияPirogov Russian National Research Medical University; Moscow State University of Medicine and DentistryRussian FederationГБУЗ города Москвы Городская клиническая больница № 52, Департамент здравоохранения г. МосквыРоссияPirogov Russian National Research Medical UniversityRussian FederationФБУН Московский научно-исследовательский институт эпидемиологии и микробиологии имени Г.Н. Габричевского, РоспотребнадзорРоссияGabrichevsky Moscow Research Institute of Epidemiology and MicrobiologyRussian FederationФБУН Московский научно-исследовательский институт эпидемиологии и микробиологии имени Г.Н. Габричевского Роспотребнадзора; ГБУЗ города Москвы Городская клиническая больница № 52, Департамент здравоохранения г. Москвы; Филиал ФГБВОУ ВО Военно-медицинская академия имени С.М. Кирова, Министерство обороны Российской Федерации в г. МосквеРоссияGabrichevsky Moscow Research Institute of Epidemiology and Microbiology; Pirogov Russian National Research Medical University; Branch of the Kirov Military Medical AcademyRussian FederationФГБВОУ ВО Военно-медицинская академия имени С.М. Кирова, Министерство обороны Российской ФедерацииРоссияKirov Military Medical AcademyRussian Federation202307042023251714Copyright © Ким И.Г., Лысенко М.А., Фролова Н.Ф., Артюхина Л.Ю., Бурулева Т.А., Никитина А.М., Виноградов В.Е., Володина Е.В., Червинко В.И., Крюков Е.В., Зубкин М.Л., 20232023Ким И.Г., Лысенко М.А., Фролова Н.Ф., Артюхина Л.Ю., Бурулева Т.А., Никитина А.М., Виноградов В.Е., Володина Е.В., Червинко В.И., Крюков Е.В., Зубкин М.Л.Kim I.G., Lysenko M.A., Frolova N.F., Artyukhina L.Y., Buruleva T.A., Nikitina A.M., Vinogradov V.E., Volodina E.V., Chervinko V.I., Kryukov E.V., Zubkin M.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1563

В период эпидемических вспышек COVID-19 терапия нейтрализующими моноклональными антителами (mAbs) особенно актуальна у пациентов с повышенным риском тяжелого течения болезни, к которым относят реципиентов почечного трансплантата (РПТ).

Цель исследования

Цель исследования: оценить эффективность и безопасность нейтрализующих mAbs у РПТ с легким и средне-тяжелым течением COVID-19.

Материалы и методы

Материалы и методы. В ретроспективное исследование включены 99 РПТ, получавших стационарное лечение по поводу COVID-19 в период с 1 сентября по 31 декабря 2021 г. Возраст пациентов составил 52,0 ± 11,5 года (М - 47,5%). В качестве mAbs применяли комбинированный препарат бамланевимаб/этесевимаб в дозе 700/1400 мг Для оценки эффективности терапии mAbs были выделены 2 группы пациентов. Группу 1 составили 33 РПТ, получавшие mAb в качестве одного из компонентов терапии, группу 2 - 66 пациентов, у которых mAbs не использовали. За конечную точку наблюдения принимали выписку пациента из стационара либо летальный исход.

Результаты

Результаты. В группе 1 после применения mAb реже, чем в контрольной группе, наблюдалось прогрессирование легочного процесса с трансформацией КТ 1-2 в КТ 3-4 (9,1% против 30,3 соответственно, p < 0,01). РПТ группы 1 значимо различались от группы 2 более низкой потребностью лечения в ОРИТ и переводе на ИВЛ (6,1% против 27,3 и 3% против 19,8 соответственно). При этом группы были сопоставимы по полу, возрасту, индексу массы тела, индексу коморбидности Charlson и сроку после ТП к началу заболевания и по исходным на момент госпитализации биохимическим параметрам крови. Только показатели СРБ и фибриногена оказались выше у больных без терапии mAbs, которых госпитализировали в более поздние сроки от начала болезни (7,7 ± 3,2 сут против 4,6 ± 1,6 в группе 1, p < 0,001). Частота назначения других видов терапии в сравниваемых группах не различалась. Применение mAbs достоверно снизило летальность с 19,7% у РПТ в группе 2 до 3% в группе 1, не оказывая негативного влияния на функцию трансплантата.

Заключение

Заключение. Терапия mAbs, применяемая в ранние сроки COVID-19 у РПТ, безопасна, препятствует развитию тяжелого течения болезни и снижает частоту неблагоприятных исходов.

 

 

Therapy with neutralizing monoclonal antibodies (mAbs) is particularly relevant during COVID-19 outbreaks in patients at high risk of severe disease, including kidney transplant recipients (KTRs).

Objective

Objective: to evaluate the efficacy and safety of neutralizing mAbs in KTRs with mild to moderate COVID-19.

Materials and methods

Materials and methods. The retrospective study included 99 KTRs who received inpatient treatment for COVID-19 between September 1 and December 31, 2021. Patients were 52.0 ± 11.5 years old (M, 47.5%). Bamlanivimab/etesevimab combination drug at a dose of 700/1400 mg was used as mAbs. To evaluate the efficacy of mAbs therapy, two groups of patients were identified. Group 1 consisted of 33 KTRs who received mAbs as one of the therapy components, while group 2 consisted of 66 patients who received no mAbs. Discharge from the hospital or death was considered as the endpoint of follow-up.

Results

Results. In group 1, after the use of mAb, progression of pulmonary process was observed less frequently than in the control group with CT1-2 transformation to CT3-4 (9.1% vs. 30.3%, respectively, p < 0.01). Group 1 KTRs differed significantly from group 2 - lower need for ICU and ventilator care (6.1% vs. 27.3% and 3% vs. 19.8%, respectively). The groups were comparable by sex, age, body mass index, Charlson Comorbidity Index (CCI) and time after kidney transplant (KTx) at the onset of the disease and by rnseline blood biochemistry parameter values at the time of hospitalization. Only C-reactive protein (CRP) and fibrinogen values were higher in the non-mAbs patients who were hospitalized later in the course of the disease (7.7 ± 3.2 days versus 4.6 ± 1.6 days in group 1, p < 0 .001). The frequency of prescription of other therapies did not differ between the compared groups. Use of mAbs significantly reduced mortality from 19.7% in KTRs in group 2 to 3% in group 1 without adverse effect on graft function. Conclusion. The use of mAbs therapy in the early stages of COVID-19 in KTRs is safe, it prevents severe COVID-19, and reduces the incidence of adverse outcomes.

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The authors declare that there are no conflicts of interest present.