UNASSIGNED: Coronavirus disease 2019 (COVID-19) poses an important risk of morbidity and of mortality, in patients after solid organ transplantation. Recommendations have been issued by various transplantation societies at the national and European level to manage the immunosuppressive (IS) regimen upon admission to intensive care unit (ICU).
UNASSIGNED: The aim of this study was to evaluate the adequacy of IS regimen minimization strategy in kidney transplant recipients hospitalized in an ICU for severe COVID-19, in relation to the issued recommendations.
UNASSIGNED: The immunosuppressive therapy was minimized in all patients, with respectively 63% and 59% of the patients meeting the local and european recommendations upon admission. During ICU stay, IS was further tapered leading to 85% (local) and 78% (european) adequacy, relative to the guidelines. The most frequent deviation was the lack of complete withdrawal of mycophenolic acid (22%). Nevertheless, the adequacy/inadequacy status was not associated to the ICU- or one-year-mortality.
UNASSIGNED: In this single-center cohort, the only variable associated with a reduction in mortality was vaccination, emphasizing that the key issue is immunization prior to infection, not restoration of immunity during ICU stay.

Hypertension is common among kidney transplant recipients and may result from traditional risk factors or transplant specific variables, which commonly include donor associated causes, immunosuppression, or transplant renal artery stenosis. Uncontrolled blood pressure in this patient population is associated with increased cardiovascular mortality and morbidity, and decreased graft survival. Despite these negative associations, there are no randomized controlled trials looking at the optimal blood pressure targets and identifying the best antihypertensive regimen for this special patient population. Multiple hypertension guidelines have been published in the last 10 years, but the Kidney Disease: Improving Global Outcomes (KDIGO) and American Society of Transplantation (AST) guidelines are the only to recommended a target blood pressure in kidney transplant recipients. In this manuscript, we will review the available evidence based on randomized clinical trials and large observational studies in kidney transplant recipients. Pending new interventional trials, we believe that: a) a blood pressure target of ≤130/80 is a reasonable goal as suggested by KDIGO; b) the choice of antihypertensive agent should be based on the patients\' other comorbidities; and c) achieving good blood pressure control is more important than the choice of the antihypertensive agent; however, the initial choice of antihypertensive medications should be calcium channel blockers, beta-blockers, diuretics, and angiotensin converting enzyme inhibitors/angiotensin receptor blockers as they have all been shown to reduce cardiovascular events in the general population.