Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.
Department of General and Digestive Surgery, Hospital Clínic, Institut d'Investigacion Biomediques August Pi-Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
Gastroenterology. 2021 Mar;160(4):1151-1163.e3. doi: 10.1053/j.gastro.2020.11.045. Epub 2020 Dec 9.
Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking.
Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis.
Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.
尽管由于合并症、免疫抑制和老龄化的高发，肝移植（LT）受者因 COVID-19 而出现不良结局的风险可能增加，但在大型研究中缺乏对其影响的详细分析。
从欧洲各地收集了实验室确诊 SARS-CoV2 感染的成年 LT 受者的数据。所有出现症状的连续患者均纳入分析。
2020 年 3 月 1 日至 6 月 27 日，从 9 个国家的 36 个中心收集了 243 例有症状的成年病例数据。39 例（16%）作为门诊患者进行管理，而 204 例（84%）需要住院治疗，包括入住 ICU（204 例中有 39 例，19.1%）。49 例（20.2%）患者在中位 13.5（10-23）天后死亡，呼吸衰竭是主要原因。多变量 Cox 回归分析后，年龄>70 岁（HR，4.16；95%CI，1.78-9.73）对生存有负面影响，而他克莫司（TAC）的使用（HR，0.55；95%CI，0.31-0.99）对生存有积极的独立影响。合并症的作用受到受者年龄的主导作用的强烈影响，随着受者年龄的增加，合并症也随之增加。在排除年龄的第二个模型中，糖尿病（HR，1.95；95%CI，1.06-3.58）和慢性肾脏病（HR，1.97；95%CI，1.05-3.67）均与死亡相关。
需要住院治疗 COVID-19 的患者中有 25%死亡，年龄>70 岁且有肾功能不全和糖尿病等合并症的患者风险更高。相反，TAC 的使用与更好的生存相关，因此鼓励临床医生保持 TAC 的常规剂量。
