Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
Am J Transplant. 2020 Jul;20(7):1849-1858. doi: 10.1111/ajt.15929. Epub 2020 May 10.
The clinical characteristics, management, and outcome of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after solid organ transplant (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%], and heart [22.2%]) recipients diagnosed with COVID-19 by March 23, 2020 at a tertiary-care center at Madrid. Median age at diagnosis was 71.0 ± 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine) was used in 50.0% of patients and had to be prematurely discontinued in 2 of them. Other antiviral regimens included hydroxychloroquine monotherapy (27.8%) and interferon-β (16.7%). As of April 4, the case-fatality rate was 27.8% (5/18). After a median follow-up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C-reactive protein levels at various points were significantly higher among recipients who experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS-CoV-2 infection has a severe course in SOT recipients.
截至 2020 年 3 月 23 日，马德里一家三级医疗中心报告了 18 例确诊的 COVID-19 病例，这些病例均来自实体器官移植（SOT）受者。18 例患者接受的移植器官分别为：肾脏[44.4%]、肝脏[33.3%]和心脏[22.2%]。诊断时的中位年龄为 71.0±12.8 岁，移植后中位时间为 9.3 年。83.3%的患者表现出发热，72.2%的患者影像学表现为单侧或双侧/多灶性实变。50.0%的患者使用洛匹那韦/利托那韦（通常联合羟氯喹），其中 2 例提前停药。其他抗病毒方案包括羟氯喹单药治疗（27.8%）和干扰素-β（16.7%）。截至 4 月 4 日，病死率为 27.8%（5/18）。中位随访 18 天从症状发作开始，30.8%（4/13）的幸存者出现进行性呼吸衰竭，7.7%（1/13）病情稳定或改善，61.5%（8/13）出院回家。在经历不良结局的受者中，各时间点的 C 反应蛋白水平显著更高。总之，这份初步报告表明，SARS-CoV-2 感染在 SOT 受者中具有严重的病程。
