2019冠状病毒病对肝移植受者的影响——一项系统评价与荟萃分析
Impact of COVID-19 on liver transplant recipients-A systematic review and meta-analysis.
作者信息
Kulkarni Anand V, Tevethia Harsh Vardhan, Premkumar Madhumita, Arab Juan Pablo, Candia Roberto, Kumar Karan, Kumar Pramod, Sharma Mithun, Rao Padaki Nagaraja, Reddy Duvvuru Nageshwar
机构信息
Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Department of Hepatology, PGIMER, Chandigarh, India.
出版信息
EClinicalMedicine. 2021 Aug;38:101025. doi: 10.1016/j.eclinm.2021.101025. Epub 2021 Jul 13.
BACKGROUND
Immunosuppression and comorbidities increase the risk of severe coronavirus disease-2019 (COVID-19) in solid organ transplant (SOT) recipients. The outcomes of COVID-19 in liver transplant (LT) recipients remain unclear. We aimed to analyse the outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients.
METHODS
The electronic databases were searched for articles published from 1 December 2019 to 20 May 2021 with MeSH terms COVID-19, SARS-CoV-2, and liver transplantation. Studies reporting outcomes in more than 10 LT recipients were included for analysis. LT vs non-LT patients with COVID-19 infection were compared for all-cause mortality, which was the primary outcome studied. We also evaluated the relation between the timing of COVID-19 infection post-LT (< one year vs > one year) and mortality.
FINDINGS
Eighteen articles reporting 1,522 COVID-19 infected LT recipients were included for the systematic review. The mean age (standard deviation [SD]) was 60·38 (5·24) years, and 68·5% were men. The mean time (SD) to COVID-19 infection was 5·72 (1·75) years. Based on 17 studies (I = 7·34) among 1,481 LT recipients, the cumulative incidence of mortality was 17·4% (95% confidence interval [CI], 15·4-19·6). Mortality was comparable between LT ( = 610) and non-LT ( = 239,704) patients, based on four studies (odds ratio [OR], 0·8 [0·6-1·08]; = 0·14). Additionally, there was no significant difference in mortality between those infected within one year vs after one year of LT (OR, 1·5 [0·63-3·56]; = 0·35). The cumulative incidence of graft dysfunction was 2·3% (1·3-4·1). Nearly 23% (20·71-25) of the LT patients developed severe COVID-19 infection. Before infection, 71% and 49% of patients were on tacrolimus and mycophenolate mofetil, respectively. Immunosuppression was modified in 55·9% (38·1-72·2) patients after COVID-19 infection.
INTERPRETATION
LT and non-LT patients with COVID-19 have a similar risk of adverse outcomes.
背景
免疫抑制和合并症会增加实体器官移植（SOT）受者发生重症冠状病毒病2019（COVID-19）的风险。肝移植（LT）受者感染COVID-19的结局尚不清楚。我们旨在分析LT受者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的结局。
方法
在电子数据库中检索2019年12月1日至2021年5月20日发表的文章，检索词为COVID-19、SARS-CoV-2和肝移植。纳入报告10例以上LT受者结局的研究进行分析。比较LT与非LT的COVID-19感染患者的全因死亡率，这是所研究的主要结局。我们还评估了LT后COVID-19感染时间（<1年与>1年）与死亡率之间的关系。
结果
纳入18篇报告1522例COVID-19感染LT受者的文章进行系统评价。平均年龄（标准差[SD]）为60.38（5.24）岁，68.5%为男性。感染COVID-19的平均时间（SD）为5.72（1.75）年。基于1481例LT受者中的17项研究（I² = 7.34），死亡率的累积发生率为17.4%（95%置信区间[CI]，15.4 - 19.6）。基于四项研究（优势比[OR]，0.8[0.6 - 1.08]；P = 0.14），LT（n = 610）和非LT（n = 239,704）患者的死亡率相当。此外，LT后1年内感染与1年后感染患者的死亡率无显著差异（OR，1.5[0.63 - 3.56]；P = 0.35）。移植物功能障碍的累积发生率为2.3%（1.3 - 4.1）。近23%（20.71 - 25）的LT患者发生了重症COVID-19感染。感染前，分别有71%和49%的患者使用他克莫司和霉酚酸酯。55.9%（38.1 - 72.2）的患者在感染COVID-19后调整了免疫抑制治疗。
解读
LT和非LT的COVID-19患者出现不良结局的风险相似。
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