General Surgery, Westchester Medical Center, Valhalla, New York.
Transplant Surgery, Westchester Medical Center, Valhalla, New York.
Transplant Proc. 2021 May;53(4):1175-1179. doi: 10.1016/j.transproceed.2021.03.010. Epub 2021 Mar 19.
Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide, with a global mortality rate of 2.2%. Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature. The treatment of COVID-19 differs based on the organ(s) transplanted. Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients. Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their posttransplant hospitalization course. This potential differentiation needs to be further explored. Here, we report 2 patients who underwent liver transplantation who acquired COVID-19 during their posttransplant recovery period in the hospital.
Two patients who underwent liver transplant and contracted COVID-19 in the early posttransplant period and were treated with hydroxychloroquine, methylprednisolone, tocilizumab, and convalescent plasma. This article includes a description of their hospital course, including treatment and recovery.
The management of post-liver transplant patients with COVID-19 infection is complicated. Strict exposure precaution practice after organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from posttransplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.
2019 年冠状病毒病（COVID-19）影响了生活的方方面面，继续削弱各国的实力。COVID-19 已导致全球超过 210 万人死亡，全球死亡率为 2.2%。目前的 COVID-19 治疗选择包括支持性呼吸护理、皮质类固醇和瑞德西韦。尽管 COVID-19 与合并症患者的发病率和死亡率增加有关，但器官移植患者 COVID-19 感染的脆弱性、临床过程、最佳管理和预后在文献中尚未得到很好的描述。COVID-19 的治疗因移植的器官而异。初步数据表明，COVID-19 肝移植患者的死亡率并未高于未移植 COVID-19 患者。表 1 列出了目前关于 COVID-19 肝移植患者的已发表数据。这些研究大多包括近期和陈旧的肝移植患者。对于在移植后住院期间感染 COVID-19 的早期肝移植患者，没有进行区分。这种潜在的区别需要进一步探讨。在这里，我们报告了 2 例肝移植后患者在移植后恢复期在医院感染 COVID-19 的病例。
2 例患者在肝移植后早期感染 COVID-19，并接受羟氯喹、甲基强的松龙、托珠单抗和恢复期血浆治疗。本文描述了他们的住院过程，包括治疗和康复情况。
COVID-19 感染的肝移植后患者的管理很复杂。强烈建议在器官移植后严格遵守暴露预防措施。广泛接种疫苗有助于预防，但仍会有患者感染 COVID-19。因此，持续研究适当的治疗方法仍然是相关和关键的。在肝移植后患者中，减少免疫抑制药物剂量并持续给予低剂量甲基强的松龙、瑞德西韦、单克隆抗体和恢复期血浆可能有助于严重 COVID-19 肺炎的治疗和康复。需要进一步的研究和移植后患者的经验来更好地描绘 COVID-19 感染在肝移植受者中的临床特征和最佳管理。
