Department of Gastroenterological Surgery and Transplantology, Center of Postgraduate Medical Education in Warsaw, Warsaw, Poland.
Department of Gastroenterological Surgery and Transplantology, Center of Postgraduate Medical Education in Warsaw, Warsaw, Poland.
Transplant Proc. 2021 May;53(4):1194-1201. doi: 10.1016/j.transproceed.2021.03.008. Epub 2021 Mar 15.
Kidney transplant recipients are at high risk of severe complications and death due to coronavirus disease 2019 (COVID-19).
The first part of the article describes a case of COVID-19 in our patient after a recent kidney transplant. The second part of the article presents the outcome of literature search from multiple resources from April 2020 until March 2021. Abstracts were screened, followed by full-text review with data extraction. Part 2 discusses current treatment options of COVID-19, and part 3 refers to this treatment application in patients after solid organ transplant.
We have summarized 45 studies from China, France, Italy, Spain, the United Kingdom, and the United States. Mortality rates from published studies were variable. Based on early data from Spain, 42% of patients who developed COVID-19 within 60 days of transplant died. According to results of the European Renal Association COVID-19 Database collaboration group, the 28-day COVID-19-related mortality is 21.3% for kidney transplant recipients, which is still markedly higher than what is observed in other populations. Acute kidney injury was common, and mycophenolate mofetil and mammalian target of rapamycin were discontinued in most patients.
Effective therapy has been sought since the outbreak of the pandemic, and at the same time intensive work has been done to produce a vaccine that could effectively protect against the disease. Summing up the efforts of numerous groups of researchers from around the world that have been continued since the beginning of 2020, we may assume the following: (1) we still do not have causal drugs that would reduce severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication and allow its complete elimination, but antispike monoclonal antibodies against SARS-CoV-2 seem to be very promising, and (2) the withdrawal of antiproliferative and antimetabolic drugs and the continuation of steroids and calcineurin inhibitors is now a commonly accepted approach in patients after organ transplant.
肾移植受者由于 2019 年冠状病毒病（COVID-19）而面临严重并发症和死亡的高风险。
本文的第一部分描述了我们的一位肾移植后近期发生 COVID-19 的患者的病例。本文的第二部分介绍了 2020 年 4 月至 2021 年 3 月期间从多个资源进行的文献检索结果。筛选了摘要，然后进行全文审查并提取数据。第 2 部分讨论了 COVID-19 的当前治疗选择，第 3 部分提到了该治疗方法在实体器官移植患者中的应用。
我们总结了来自中国、法国、意大利、西班牙、英国和美国的 45 项研究。发表研究的死亡率各不相同。根据来自西班牙的早期数据，42%的患者在移植后 60 天内发生 COVID-19 死亡。根据欧洲肾脏协会 COVID-19 数据库协作组的结果，肾移植受者的 28 天 COVID-19 相关死亡率为 21.3%，仍明显高于其他人群。急性肾损伤很常见，大多数患者停用了霉酚酸酯和哺乳动物雷帕霉素靶蛋白。
自疫情爆发以来，人们一直在寻找有效的治疗方法，同时也在加紧研制一种能有效预防该病的疫苗。总结 2020 年初以来来自世界各地的众多研究小组的努力，我们可以做出如下假设：（1）我们仍然没有能降低严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）复制并使其完全消除的因果药物，但针对 SARS-CoV-2 的抗刺突单克隆抗体似乎很有前途，（2）现在，在器官移植受者中，停用抗增殖和抗代谢药物并继续使用类固醇和钙调磷酸酶抑制剂是一种普遍接受的方法。
