Regele Florina, Oberbauer Rainer
Univ. Klinik für Innere Medizin III, Klinische Abteilung für Nephrologie und Dialyse, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich.
Nephrologe. 2021;16(3):129-137. doi: 10.1007/s11560-021-00485-3. Epub 2021 Jan 28.
The coronavirus disease 2019 (COVID-19) pandemic poses a particular risk for kidney transplant recipients. This is due to a high prevalence of comorbidities as well as therapeutic immunosuppression, which plays a complex role in view of the severe hyperinflammation contributing to morbidity and mortality. Many published case series including kidney transplant recipients reported a high proportion of hospitalized cases and mortality rates of 13-23%. The clinical symptoms and established risk factors for severe disease seem to be similar to those of the general population. The management of immunosuppressive treatment is a delicate question in the treatment of kidney transplant recipients with COVID-19. According to the current recommendations, a stepwise reduction should be carried out depending on the clinical course of the disease. Ongoing efforts to find an effective treatment for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) focus on repurposing known antiviral and anti-inflammatory substances. To date, only dexamethasone has shown to be an effective treatment in the subgroup of patients requiring oxygen supplementation; however, countless trials including novel therapeutic approaches are ongoing.
2019年冠状病毒病(COVID-19)大流行给肾移植受者带来了特殊风险。这是由于合并症的高患病率以及治疗性免疫抑制,鉴于严重的过度炎症会导致发病和死亡,免疫抑制起着复杂的作用。许多已发表的包括肾移植受者在内的病例系列报告显示,住院病例比例很高,死亡率为13%至23%。严重疾病的临床症状和既定风险因素似乎与普通人群相似。在治疗感染COVID-19的肾移植受者时,免疫抑制治疗的管理是一个棘手的问题。根据当前建议,应根据疾病的临床过程逐步减少免疫抑制剂用量。目前正在努力寻找针对严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)的有效治疗方法,重点是重新利用已知的抗病毒和抗炎物质。迄今为止,只有地塞米松在需要吸氧的患者亚组中显示出是一种有效的治疗方法;然而,包括新型治疗方法在内的无数试验正在进行中。