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Kidney transplant recipients are at an elevated risk of COVID-19 mortality. Cyclosporine A with COVID-19 could enhance kidney transplant recipients results since cyclosporine A has both antiviral and immunomodulatory properties. Therefore, we aimed to explore the link between the use of cyclosporine A with COVID-19 in kidney transplant recipients as maintenance immunosuppression and mortality, severity, acute kidney injury, and the need for intensive care unit care.
We searched comprehensive literature from various databases. Cyclosporine A was continued at low dose to maintain certain target concentrations and only discontinued in case of lifethreatening situation. The major outcome was death, and the secondary outcomes were extreme COVID-19, acute kidney injury, and the need for intensive care unit treatment.
A total of 146 patients from 5 studies were analyzed. The use of cyclosporine A as maintenance immunosuppressive therapy in kidney transplant recipients was associated significantly with lower mortality from COVID-19 (RR 0.36 [0.16, 0.85], p=0.02; I2: 0%, p=0.44). The use of cyclosporine A in kidney transplant recipients with COVID-19 was not significant for lower risk of severe COVID-19 (RR 0.81 [0.55, 1.18], p=0.27; I2: 0%, p=0.60). The use of cyclosporine A was not associated with the risk of acute kidney injury (RR 1.03 [0.07, 15.41], p=0.98; I2: 64%, p=0.10) or intensive care unit admission (RR 0.96 [0.18, 5.09], p=0.96; I2: 0%, p=0.87).
The use of cyclosporine A for the maintenance of kidney graft during COVID-19 is associated with lower mortality than other immunosuppressive therapy regimens.