Demir Erol, Uyar Murathan, Parmaksiz Ergun, Sinangil Ayse, Yelken Berna, Dirim Ahmet Burak, Merhametsiz Ozgur, Yadigar Serap, Atan Ucar Zuhal, Ucar Ali Riza, Demir Mehmet Emin, Mese Meral, Akin Emin Baris, Garayeva Nurana, Safak Seda, Oto Ozgur Akin, Yazici Halil, Turkmen Aydin
Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Division of Nephrology, Department of Internal Medicine, Gaziosmanpasa Hospital, Yeniyuzyil University, Istanbul, Turkey.
Transpl Infect Dis. 2020 Oct;22(5):e13371. doi: 10.1111/tid.13371. Epub 2020 Jul 13.
Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19.
Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation.
Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up.
COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.
肾移植受者的新型冠状病毒肺炎（COVID-19）管理应包括感染治疗、免疫抑制调节和支持治疗。然而，在这个问题上尚未达成共识。本研究旨在分享我们对诊断为COVID-19的肾移植受者的经验。
本回顾性队列研究纳入了来自土耳其伊斯坦布尔五个主要移植中心诊断为COVID-19的肾移植受者。分析时将患者分类为患有中度或重度肺炎。主要终点是全因死亡率。次要终点是急性肾损伤、平均住院时间、入住重症监护病房以及机械通气。
在诊断为COVID-19后的32天随访期内，对40例患者进行了回顾性分析。咳嗽、发热和呼吸困难是所有患者中最常见的症状。与中度肺炎组相比，重度肺炎组既往诱导和抗排斥治疗的频率显著更高。使用环孢素A的患者均未发生重度肺炎。5例患者在重症监护病房随访期间死亡。随访期间无患者发生移植物丢失。
已发现COVID-19在肾移植受者中更常引起中度或重度肺炎。这些患者应谨慎减少免疫抑制。在大流行期间，肾移植受者应谨慎避免使用淋巴细胞清除剂进行诱导治疗。
