新冠疫情期间的肝移植免疫抑制
Liver transplant immunosuppression during the covid-19 pandemic.
作者信息
Forns Xavier, Navasa Miquel
机构信息
Unidad de Hepatitis Víricas y Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Clínic. Universitat de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
Unidad de Hepatitis Víricas y Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Clínic. Universitat de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
出版信息
Gastroenterol Hepatol. 2020 Oct;43(8):457-463. doi: 10.1016/j.gastrohep.2020.06.003. Epub 2020 Jun 12.
SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression.
严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染引发了一场大流行,给我们的医疗系统带来了严重后果。尽管肝移植患者仅占总人口的少数,但负责这些患者的肝病专家已努力协调各方力量,制定了SARS-CoV-2感染期间免疫抑制管理方案。虽然目前尚无确凿研究支持一般性建议,但其他病毒感染(丙型肝炎、巨细胞病毒)的经验表明,在不使用霉酚酸酯或m-Tor抑制剂(这些药物也与白细胞减少和淋巴细胞减少有关)的情况下进行免疫抑制管理可能有益。关注可能的药物相互作用也很重要,尤其是在他克莫司的情况下,它与COVID-19治疗中使用的一些具有抗病毒作用的药物(洛匹那韦/利托那韦、阿奇霉素)之间存在相互作用。最后,应考虑给予重症肺病患者的免疫调节药物(托珠单抗及类似药物)的免疫抑制作用。本文回顾了不同免疫抑制药物的作用机制,以及它们对SARS-CoV-2感染的潜在影响,并提出了免疫抑制管理指南。