Swisstransplant, Berne, Switzerland / University of Zurich Faculty of Medicine, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Swiss Med Wkly. 2020 Dec 31;150:w20451. doi: 10.4414/smw.2020.20451. eCollection 2020 Dec 14.
The impact of coronavirus disease 2019 (COVID-19) on patients listed for solid organ transplantation has not been systematically investigated to date. Thus, we assessed occurrence and effects of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on patients on the Swiss national waiting list for solid organ transplantation.
Patient data were retrospectively extracted from the Swiss Organ Allocation System (SOAS). From 16 March to 31 May 2020, we included all patients listed for solid organ transplantation on the Swiss national waiting list who were tested positive for SARS-CoV-2. Severity of COVID-19 was categorised as follows: stage I, mild symptoms; stage II, moderate to severe symptoms; stage III, critical symptoms; stage IV, death. We compared the incidence rate (laboratory-confirmed cases of SARS-CoV-2), the hospital admission rate (number of admissions of SARS-CoV-2-positive individuals), and the case fatality rate (number of deaths of SARS-CoV-2-positive individuals) in our study population with the general Swiss population during the study period, calculating age-adjusted standardised incidence ratios and standardised mortality ratios, with 95% confidence intervals (CIs).
A total of 1439 patients were registered on the Swiss national solid organ transplantation waiting list on 31 May 31 2020. Twenty-four (1.7%) waiting list patients were reported to test positive for SARS-CoV-2 in the study period. The median age was 56 years (interquartile range 45.3–65.8), and 14 (58%) were male. Of all patients tested positive for SARS-CoV-2, two patients were asymptomatic, 14 (58%) presented in COVID-19 stage I, 3 (13%) in stage II, and 5 (21%) in stage III. Eight patients (33%) were admitted to hospital, four (17%) required intensive care, and three (13%) mechanical ventilation. Twenty-two patients (92%) of all those infected recovered, but two male patients aged >65 years with multiple comorbidities died in hospital from respiratory failure. Comparing our study population with the general Swiss population, the age-adjusted standardised incidence ratio was 4.1 (95% CI 2.7–6.0).
The overall rate of SARS-CoV-2 infections in candidates awaiting solid organ transplantation was four times higher than in the Swiss general population; however, the frequency of testing likely played a role. Given the small sample size of affected patients, conclusions have to be drawn cautiously and results need verification in larger cohorts.
迄今为止，尚未系统研究 2019 年冠状病毒病（COVID-19）对实体器官移植受者的影响。因此，我们评估了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染对瑞士国家实体器官移植等候名单上患者的发生和影响。
患者数据从瑞士器官分配系统（SOAS）中回顾性提取。从 2020 年 3 月 16 日至 5 月 31 日，我们纳入了所有在瑞士国家等候名单上接受实体器官移植的患者，这些患者的 SARS-CoV-2 检测呈阳性。COVID-19 的严重程度分类如下：I 期，轻度症状；II 期，中度至重度症状；III 期，危急症状；IV 期，死亡。我们将研究人群中的发病率（实验室确诊的 SARS-CoV-2 病例）、住院率（SARS-CoV-2 阳性个体的入院人数）和病死率（SARS-CoV-2 阳性个体的死亡人数）与研究期间的瑞士一般人群进行比较，计算年龄调整后的标准化发病率比和标准化死亡率比，置信区间（CI）为 95%。
2020 年 5 月 31 日，共有 1439 名患者登记在瑞士国家实体器官移植等候名单上。在研究期间，报告有 24 名（1.7%）等候名单患者的 SARS-CoV-2 检测呈阳性。中位年龄为 56 岁（四分位距 45.3–65.8），14 名（58%）为男性。所有 SARS-CoV-2 检测呈阳性的患者中，有 2 名无症状，14 名（58%）为 COVID-19 期 I，3 名（13%）为期 II，5 名（21%）为期 III。8 名（33%）患者住院，4 名（17%）需要重症监护，3 名（13%）需要机械通气。所有感染者中有 22 名（92%）康复，但 2 名年龄>65 岁、合并多种合并症的男性患者因呼吸衰竭在医院死亡。与瑞士一般人群相比，我们的研究人群的年龄调整后标准化发病率比为 4.1（95%CI 2.7–6.0）。
候选实体器官移植患者的 SARS-CoV-2 感染总发生率是瑞士一般人群的 4 倍，但检测频率可能起了作用。由于受影响患者的样本量较小，因此必须谨慎得出结论，并需要在更大的队列中验证结果。
