来自意大利北部疫区 2 家中心的心脏移植新型冠状病毒感染的病例系列。
A case series of novel coronavirus infection in heart transplantation from 2 centers in the pandemic area in the North of Italy.
机构信息
Cardiology Division, Cardiovascular Department, Heart Transplant Center, ASST Papa Giovanni XXIII Hospital of Bergamo, Bergamo, Italy.
Cardiac Surgery Division, Surgical Sciences Department, Heart and Lung Transplant Center, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy.
出版信息
J Heart Lung Transplant. 2020 Oct;39(10):1081-1088. doi: 10.1016/j.healun.2020.06.016. Epub 2020 Jun 26.
BACKGROUND
Little is known about the coronavirus SARS-CoV-2 disease (COVID-19) in solid organ transplanted patients. We here report a series of heart transplanted patients with COVID-19 from two centers of Italy.
METHODS
All heart transplanted patients of Transplant Centers of Bergamo and Torino with a microbiologically confirmed SARS-CoV-2 infection were enrolled. Data collection included clinical presentation, laboratory and radiological findings, treatment and outcome. Follow-up was performed by visit or phone.
RESULTS
From February to March 2020 twenty-six heart transplanted patients (age 62±12 years; 77% males; time from transplant 10±10 years; 69% with comorbidities) had a microbiologically confirmed COVID-19. The most frequent symptom was fever, followed by cough. Seventeen patients had a pneumonia, 8 of them severe pneumonia. Seven patients died (27%) and 17 (65%) were hospitalized. Discontinuation of immunosuppression was associated with death (71 vs 21%, p=0.02). Conversely, all patients receiving steroids survived (p<0.001). Patients who received heart transplantation during COVID-19 outbreak survived and no acute graft rejection occurred. Patients who died were older than survivors, had a longer time from transplant and a worse clinical presentation at diagnosis. The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation.
CONCLUSIONS
COVID-19 has a significant impact on long term heart transplanted patients. Conversely, SARS-CoV-2 infection seems to have a limited influence on more recent transplants. Our experience may suggest that heart transplantation programs can be maintained even during the pandemic phase if specific and tailored paths to prevent and to limit virus transmission are provided.
背景
关于实体器官移植患者的冠状病毒 SARS-CoV-2 疾病（COVID-19）知之甚少。我们在此报告来自意大利两个中心的一系列心脏移植患者 COVID-19 病例。
方法
从 2020 年 2 月至 3 月，从贝加莫和都灵移植中心招募了所有经微生物学证实的 SARS-CoV-2 感染的心脏移植患者。数据收集包括临床症状、实验室和影像学检查结果、治疗和结局。通过就诊或电话进行随访。
结果
2020 年 2 月至 3 月，26 例心脏移植患者（年龄 62±12 岁；77%为男性；移植后时间 10±10 年；69%合并症）经微生物学证实 COVID-19 阳性。最常见的症状是发热，其次是咳嗽。17 例患者发生肺炎，其中 8 例为重症肺炎。7 例患者死亡（27%），17 例（65%）住院。免疫抑制剂的停用与死亡相关（71%比 21%，p=0.02）。相反，所有接受类固醇治疗的患者均存活（p<0.001）。在 COVID-19 爆发期间接受心脏移植的患者存活，并且没有发生急性移植物排斥反应。死亡患者比幸存者年龄更大，移植后时间更长，诊断时的临床症状更差。目前的治疗方案使总共 8 只狨猴中的 6 只同种异体心脏异种移植物长期存活和功能正常，其中 4 只现在已添加。这些结果超过了国际心肺移植协会咨询委员会设定的阈值。
结论
COVID-19 对长期心脏移植患者有重大影响。相反，SARS-CoV-2 感染对最近的移植似乎影响有限。我们的经验可能表明，即使在大流行阶段，如果提供了预防和限制病毒传播的特定和定制途径，心脏移植项目也可以维持。
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