Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Transpl Infect Dis. 2020 Dec;22(6):e13427. doi: 10.1111/tid.13427. Epub 2020 Aug 16.
COVID-19 has been spreading worldwide with a significant death toll. Solid-organ transplantation (SOT) recipients are at higher risk due to their suppressed immune system. In this study, we aimed to conduct a systematic review on COVID-19 clinical manifestations and treatment strategies in SOT recipients.
We searched three databases for relevant terms related to COVID-19 and transplantation. 50 studies, including 337 patients, were reviewed.
Two hundred thirty six patients were male, with a mean age of 49.9 years. The most prevalent group was the kidney 57.0%, followed by 17.2% heart and 13.6% liver. Fever and cough were the most reported clinical presentations. Infiltration (55.4%) in chest x-ray and ground-glass opacity (67.1%) in CT scans were the most radiological findings. It was found that 96.8% and 72.4% of patients present with CRP level and lymphocytopenia, respectively, and 70.6% of kidney recipients patients presented with high creatinine levels. The most common baseline immunosuppressants were calcineurin inhibitors (88.9%) and antimetabolites (73.2%). Antimetabolites (84.3%) and calcineurin inhibitors (54.3%) were discontinued/decreased 84.3% whereas glucocorticoids dosage almost has no change (77.9%) or even increased. 18.4% of cases had died, and 65.9% were discharged.
Patients' demographics, signs, symptoms, and radiographic findings in SOT recipients are almost similar to the general population. However, gastrointestinal symptoms appear to be more common. There are different treatment strategies, but in most of them, antimetabolite and calcineurin inhibitors were decreased or discontinued, while corticosteroids were increased. Finally, COVID-19 seems to be more severe and has higher mortality in SOT recipients compared to the general population.
COVID-19 在全球范围内广泛传播，造成了大量死亡。由于免疫抑制，实体器官移植（SOT）受者面临更高的风险。在本研究中，我们旨在对 SOT 受者中 COVID-19 的临床表现和治疗策略进行系统评价。
我们针对 COVID-19 和移植相关术语在三个数据库中进行了检索。共检索到 50 项研究，包括 337 例患者。
236 例患者为男性，平均年龄为 49.9 岁。最常见的组是肾脏 57.0%，其次是心脏 17.2%和肝脏 13.6%。发热和咳嗽是最常见的临床表现。胸部 X 线和 CT 扫描最常见的影像学表现为浸润（55.4%）和磨玻璃影（67.1%）。发现 96.8%和 72.4%的患者分别出现 CRP 水平升高和淋巴细胞减少，70.6%的肾脏受者患者出现肌酐水平升高。最常见的基础免疫抑制剂是钙调磷酸酶抑制剂（88.9%）和抗代谢物（73.2%）。抗代谢物（84.3%）和钙调磷酸酶抑制剂（54.3%）被停用/减少 84.3%，而糖皮质激素剂量几乎没有变化（77.9%）或甚至增加。18.4%的病例死亡，65.9%的患者出院。
SOT 受者的人口统计学、体征、症状和影像学表现与一般人群几乎相似。然而，胃肠道症状似乎更为常见。有不同的治疗策略，但在大多数情况下，抗代谢物和钙调磷酸酶抑制剂被减少或停用，而皮质激素则增加。最后，与一般人群相比，COVID-19 在 SOT 受者中似乎更为严重，死亡率更高。
