Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France; INSERM, IRM UMR-S 1109, University of Strasbourg, Strasbourg, France.
Department of Nephrology and Transplantation, Necker University Hospital - APHP, Paris, France; INEM INSERM U 1151- CNRS UMR 8253, Paris University, Paris, France.
Kidney Int. 2020 Dec;98(6):1549-1558. doi: 10.1016/j.kint.2020.08.005. Epub 2020 Aug 24.
Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day mortality 22.8%). Multivariable analysis identified overweight, fever, and dyspnea as independent risk factors for severe disease, whereas age over 60 years, cardiovascular disease, and dyspnea were independently associated with mortality. Thus, Covid-19 in recipients of kidney transplants portends a high mortality rate. Proper management of immunosuppression and tailored treatment of this population remain challenging.
尽管目前仍在持续发生 2019 年冠状病毒病（COVID-19）大流行，但有关其在肾移植受者中的临床表现和预后的信息仍然很少。本基于登记的观察性研究旨在探讨纳入法国实体器官移植受者 COVID-19 全国登记处的肾移植受者的特征和临床结局。COVID-19 诊断基于有症状的患者，其 SARS-CoV-2 的 PCR 检测呈阳性或影像学上有典型的肺部病变。记录了临床和实验室特征、免疫抑制治疗管理、COVID-19 治疗以及临床结局（住院、入住重症监护病房、机械通气或死亡）。确定了严重疾病或死亡的危险因素。在 279 例患者中，243 例住院，36 例在家管理。住院患者的中位年龄为 61.6 岁；大多数有合并症（高血压 90.1%；超重 63.8%；糖尿病 41.3%；心血管疾病 36.2%）。入院时最常见的症状是发热、咳嗽、呼吸困难和腹泻。实验室检查发现轻度炎症，常伴有淋巴细胞减少。免疫抑制剂药物通常被停用（钙调磷酸酶抑制剂：28.7%；抗代谢物：70.8%）。治疗主要基于羟氯喹（24.7%）、抗病毒药物（7.8%）和托珠单抗（5.3%）。106 例患者发生严重 COVID-19（46%）。43 例住院患者死亡（30 天死亡率 22.8%）。多变量分析确定超重、发热和呼吸困难是严重疾病的独立危险因素，而年龄超过 60 岁、心血管疾病和呼吸困难与死亡率独立相关。因此，肾移植受者中的 COVID-19 预示着高死亡率。适当管理免疫抑制和为该人群量身定制治疗仍然具有挑战性。
