Effect of Calcineurin Inhibitors and Mammalian Target of Rapamycin Inhibitors on the Course of COVID-19 in Kidney Transplant Recipients

Ann Transplant. 2021 Mar 12;26:e929279. doi: 10.12659/AOT.929279.


Coronavirus disease 19 (COVID-19) has been an ongoing pandemic since December 2019. Unfortunately, kidney transplant recipients are a high-risk group during the disease course, and scientific data are still limited in this patient group. Beyond the dosage of immunosuppressive drugs, pharmacological immunosuppression may also alter the infection response in the COVID-19 course. The effects of immunosuppressive agents on the development and process of infection should not be decided only by determining how potent they are and how much they suppress the immune system; it is also thought that the direct effect of the virus, increased oxidative stress, and cytokine storm play a role in the pathogenesis of COVID-19 disease. There are data about immunosuppressive drugs like calcineurin inhibitors (CNI) or mammalian target of rapamycin inhibitors (mTORi) therapy related to their beneficial effects during any infection course. Limited data suggest that the use of CNI or mTORi may have beneficial effects on the process. In this hypothetical review, the probable impacts of CNI and mTORi on the pathogenesis of the COVID-19 were investigated.

Publication types

  • Review

MeSH terms

  • Adaptive Immunity / drug effects
  • COVID-19 / diagnosis
  • COVID-19 / immunology*
  • Calcineurin Inhibitors / pharmacology
  • Calcineurin Inhibitors / therapeutic use*
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / prevention & control
  • Cytokine Release Syndrome / virology
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control*
  • Humans
  • Immunity, Innate / drug effects
  • Immunocompromised Host
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Oxidative Stress / drug effects
  • Oxidative Stress / immunology
  • Postoperative Complications / diagnosis
  • Postoperative Complications / immunology*
  • Postoperative Complications / virology
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use*
  • TOR Serine-Threonine Kinases / antagonists & inhibitors


  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Protein Kinase Inhibitors
  • TOR Serine-Threonine Kinases