Institute of Hepatobiliary Diseases, Transplant Center, Hubei Key Laboratory of Medical Technology on Transplantation, Zhongnan Hospital, Wuhan University, Wuhan, China.
Transplantation Medicine Engineering and Technology Research Center, National Health Commission, The 3rd Xiangya Hospital of Central South University, Changsha, China.
Transpl Infect Dis. 2021 Feb;23(1):e13425. doi: 10.1111/tid.13425. Epub 2020 Aug 11.
There is no consensus on immunosuppression management for kidney transplant recipients (KTRs) with SARS-CoV-2 pneumonia. Therefore, we conducted a search in English database from October 2019 to July 2020 and extracted data from cases with treatment details worldwide, and total of 41 recipients with a median age of 50 years were enrolled in this study. Most of them were males (75.8%). The most common presenting symptoms were fever (80.5%), cough (63.4%), and fatigue (41.5%). Patients were classified into three catalogs according to severity of pneumonia: 17 (41.5%) were mild, 15 (36.6%) severe, and 9 (21.9%) critical disease. Laboratory tests revealed that serum creatinine of critical patients was significantly higher than that of mild or severe patients. 68.3% received oxygen support; all patients received antiviral therapy, and 15 (36.6%) recipients were additionally treated with intravenous immunoglobulin and interferon-α. 19.5% of patients maintained immunosuppressive therapy; 36.6% suspended antimetabolite; and 43.9% only treated with corticosteroid. Six (14.6%) patients died (severe: 2, critical: 4); high creatinine with low lymphocyte count was the biggest challenge of immunosuppression management. In all, it is necessary to pay close attention to renal function and lymphocyte count in KTRs infected with COVID-19 and choose appropriate medication programs according to the specific situations.
对于感染 SARS-CoV-2 的肾移植受者（KTR），免疫抑制管理尚无共识。因此，我们在 2019 年 10 月至 2020 年 7 月间对英文数据库进行了检索，并提取了全球有治疗细节的病例数据，共纳入 41 例中位年龄 50 岁的受者。他们大多数为男性（75.8%）。最常见的表现症状为发热（80.5%）、咳嗽（63.4%）和乏力（41.5%）。根据肺炎严重程度，患者分为三个类别：17 例（41.5%）为轻症、15 例（36.6%）为重症和 9 例（21.9%）为危重症。实验室检查显示，危重症患者的血肌酐显著高于轻症或重症患者。68.3%的患者接受了氧疗支持；所有患者均接受了抗病毒治疗，15 例（36.6%）患者另外接受了静脉免疫球蛋白和干扰素-α治疗。19.5%的患者维持免疫抑制治疗；36.6%的患者停用了代谢抑制剂；43.9%的患者仅接受了皮质类固醇治疗。6 例（14.6%）患者死亡（重症：2 例，危重症：4 例）；免疫抑制管理最大的挑战是高肌酐伴低淋巴细胞计数。总之，对于感染 COVID-19 的 KTR，需要密切关注肾功能和淋巴细胞计数，并根据具体情况选择合适的药物治疗方案。
