COVID-19 感染后心脏移植早期的临床病程和具有挑战性的管理：两例患者的病例报告。
Clinical course and challenging management of early COVID-19 infection after heart transplantation: case report of two patients.
机构信息
Department of Cardiovascular Surgery, CHU Liege, B35 SART TILMAN, 4000, Liege, Belgium.
Department of Cardiology, CHU Liege, Liege, Belgium.
出版信息
BMC Infect Dis. 2021 Jan 20;21(1):89. doi: 10.1186/s12879-021-05793-6.
BACKGROUND
There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state.
CASE PRESENTATION
This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplant recipients who tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil.
CONCLUSIONS
These two cases illustrate the severity and poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory, and the issue of asymptomatic carriers needs to be addressed.
背景
目前关于 2019 年冠状病毒病（COVID-19）在实体器官移植患者中的数据有限，特别是在心脏移植受者中，迄今仅描述了少数病例报告和病例系列。由于心脏移植受者存在合并症和免疫抑制状态，因此他们可能面临特别高的风险。
病例介绍
本报告描述了两名心脏移植受者在移植手术围手术期检测出 SARS-CoV-2 病毒阳性后的 COVID-19 早期感染的临床经过和具有挑战性的治疗管理。这两名患者发展为严重疾病，尽管开始使用羟氯喹进行抗病毒单药治疗并中断吗替麦考酚酯，但最终仍死亡。
结论
这两个病例说明了 COVID-19 在心脏移植围手术期的严重性和不良预后。对供体和受体进行彻底筛查是强制性的，需要解决无症状携带者的问题。
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