Division of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
Turk J Med Sci. 2021 Apr 30;51(2):428-434. doi: 10.3906/sag-2007-260.
BACKGROUND/AIM: We aimed to identify clinical settings of renal transplant patients with COVID-19.
In this retrospective study, we included kidney transplant inpatients with laboratory confirmed COVID-19 who had been discharged or had died by October 1st, 2020. Characteristics of the patients, including basal and last outpatient biochemical parameters were recorded. Discontinuation or dosage reduction of immunosuppressives and other treatment information was documented.
Twenty patients were included in this study, of whom 18 were discharged and 2 died in hospital. The mean duration of hospitalization and follow-up were 9.7 ± 6.4 days and 4.5 ± 2.0 months, respectively. Fourteen patients (70%) were male and mean age was 48.0 ± 10.3 years. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/ day (50%) or dexamethasone (50%). Tacrolimus/m-TOR inhibitors were reduced by 50% and all antimetabolites were discontinued. Hemodialysis was needed for 10% of patients. Acute kidney injury was detected in 25% of the patients. With respect to hospitalization time and complications, there was no significant difference between patients who used dexamethasone and those who did not (P > 0.05). The discontinued immunosuppressives were resumed within 2 to 4 weeks after discharge according to the severity of disease. No rehospitalization or acute rejection was detected during the follow-up of the patients.
Renal transplant patients are considered a high risk group for COVID-19. It can be said that discontinuation or reducing dosages of immunosuppressives may be effective and safe in kidney transplant patients.
背景/目的：我们旨在确定 COVID-19 肾移植患者的临床环境。
在这项回顾性研究中，我们纳入了已出院或截至 2020 年 10 月 1 日在院死亡的实验室确诊 COVID-19 的肾移植住院患者。记录患者的特征，包括基础和最后一次门诊生化参数。记录免疫抑制剂的停药或剂量减少以及其他治疗信息。
本研究共纳入 20 例患者，其中 18 例出院，2 例在院死亡。住院和随访的平均时间分别为 9.7 ± 6.4 天和 4.5 ± 2.0 个月。14 例患者（70%）为男性，平均年龄为 48.0 ± 10.3 岁。入院时，所有患者均停用免疫抑制剂，并开始使用 16mg/天的甲泼尼龙（50%）或地塞米松（50%）。他克莫司/mTOR 抑制剂减少 50%，所有抗代谢物均停用。10%的患者需要血液透析。25%的患者出现急性肾损伤。在住院时间和并发症方面，使用地塞米松和未使用地塞米松的患者之间无显著差异（P > 0.05）。根据疾病严重程度，出院后 2 至 4 周内恢复停用的免疫抑制剂。在患者随访期间未发现再住院或急性排斥反应。
肾移植患者被认为是 COVID-19 的高危人群。可以说，在肾移植患者中，停用或减少免疫抑制剂的剂量可能是有效且安全的。
