Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Transplantation. 2021 Jan 1;105(1):138-150. doi: 10.1097/TP.0000000000003460.
The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management.
Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected.
Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI.
In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.
在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）流行期间，实体器官移植（SOT）患者的流行病学和临床特征尚不清楚。我们进行了一项匹配的回顾性队列研究，比较了 SOT 受者与普通人群的临床结局，并评估了免疫抑制管理。
2020 年 3 月 11 日至 4 月 25 日，西班牙巴塞罗那一家三级保健医院收治了经实验室聚合酶链反应确诊的 SARS-CoV-2 感染的成年 SOT 受者，根据性别、年龄和年龄调整 Charlson 指数，对这些患者与对照组（1:4）进行了匹配。从入院之日起或截止至截止日期后 28 天对患者进行随访。主要终点是 28 天死亡率。次要终点包括入住重症监护病房和继发性并发症。收集了免疫抑制剂与新型冠状病毒病 2019（COVID-19）管理药物之间的药物-药物相互作用（DDI）。
纳入 46 名移植受者和 166 名对照患者。移植受者和对照组的平均（SD）年龄分别为 62.7（12.6）和 66.0（12.7）岁，33（71.7%）和 122（73.5%）为男性，中位数（四分位距）Charlson 指数分别为 5（3-7）和 4（2-7）。SOT 受者的死亡率为 37.0%，对照组为 22.9%（P=0.51）。由于潜在或确认的 DDI，33（71.7%）名患者暂时停止了免疫抑制剂治疗。
总之，与对照组相比，COVID-19 住院 SOT 受者的死亡率有升高趋势，但无统计学意义，且有明显的 DDI 倾向。
