Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy.
Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy.
Kidney Int. 2020 Jun;97(6):1083-1088. doi: 10.1016/j.kint.2020.04.002. Epub 2020 Apr 9.
The outcome of SARS-CoV2 infection in patients who have received a kidney allograft and are being treated with immunosuppression is unclear. We describe 20 kidney transplant recipients (median age 59 years [inter quartile range 51-64 years], median age of transplant 13 years [9-20 years], baseline eGFR 36.5 [23-47.5]) with SARS-CoV2 induced pneumonia. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/day, all but one was commenced on antiviral therapy and hydroxychloroquine with doses adjusted for kidney function. At baseline, all patients presented fever but only one complained of difficulty in breathing. Half of patients showed chest radiographic evidence of bilateral infiltrates while the other half showed unilateral changes or no infiltrates. During a median follow-up of seven days, 87% experienced a radiological progression and among those 73% required escalation of oxygen therapy. Six patients developed acute kidney injury with one requiring hemodialysis. Six of 12 patients were treated with tocilizumab, a humanized monoclonal antibody to the IL-6 receptor. Overall, five kidney transplant recipients died after a median period of 15 days [15-19] from symptom onset. These preliminary findings describe a rapid clinical deterioration associated with chest radiographic deterioration and escalating oxygen requirement in renal transplant recipients with SARS-Cov2 pneumonia. Thus, in this limited cohort of long-term kidney transplant patients, SARS-CoV-2 induced pneumonia is characterized by high risk of progression and significant mortality.
肾移植受者在接受免疫抑制治疗的情况下感染 SARS-CoV-2 的结果尚不清楚。我们描述了 20 例肾移植受者(中位年龄 59 岁 [四分位距 51-64 岁],中位移植年龄 13 岁 [9-20 岁],基线 eGFR 36.5 [23-47.5])患有 SARS-CoV-2 引起的肺炎。入院时,所有患者均停用免疫抑制剂,并开始每日服用 16mg 甲基强的松龙,除 1 例患者外,所有患者均开始接受抗病毒治疗和羟氯喹治疗,并根据肾功能调整剂量。基线时,所有患者均有发热,但只有 1 例患者主诉呼吸困难。半数患者的胸部 X 线显示双侧浸润,另一半患者显示单侧改变或无浸润。在中位随访 7 天期间,87%的患者出现放射学进展,其中 73%需要升级氧疗。6 例患者发生急性肾损伤,其中 1 例需要血液透析。12 例患者中有 6 例接受了托珠单抗治疗,托珠单抗是一种针对 IL-6 受体的人源化单克隆抗体。总体而言,中位发病后 15 天 [15-19],有 5 例肾移植受者死亡。这些初步结果描述了肾移植受者 SARS-CoV-2 肺炎与胸部 X 线恶化和氧气需求不断增加相关的快速临床恶化。因此,在这个有限的长期肾移植患者队列中,SARS-CoV-2 引起的肺炎具有进展和死亡率高的特点。