Becchetti Chiara, Gschwend Sarah Gabriela, Dufour Jean-François, Banz Vanessa
University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Hepatology, Department of Biomedical Research, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2021 Sep 5;10(17):4015. doi: 10.3390/jcm10174015.
Liver transplant (LT) recipients are considered a vulnerable population amidst the COVID-19 pandemic. To date, available data have been heterogeneous and scarce. Therefore, we conducted a systematic literature review identifying English-language articles published in PubMed between November 2019 and 30 May 2021. We aimed to explore three areas: (1) outcome and clinical course; (2) immunological response after COVID-19 in LT recipients; and (3) vaccination response. After systematic selection, 35, 4, and 5 articles, respectively, were considered suitable for each area of analysis. Despite the heterogeneity of the reports included in this study, we found that gastrointestinal symptoms were common in LT recipients. The outcome of the LT population was not per se worse compared to the general population, although careful management of immunosuppressive therapy is required. While a complete therapy discontinuation is not encouraged, caution needs to be taken with use of mycophenolate mofetil (MMF), favoring tacrolimus (TAC) use. Although data conflicted about acquired immunity after SARS-CoV-2 infection, vaccine immunogenicity appeared to be low, suggesting that the level of surveillance should be kept high in this population.
在新冠疫情期间，肝移植（LT）受者被视为弱势群体。迄今为止，可用数据参差不齐且稀缺。因此，我们进行了一项系统的文献综述，确定了2019年11月至2021年5月30日期间发表在PubMed上的英文文章。我们旨在探讨三个方面：（1）结局和临床过程；（2）LT受者感染新冠病毒后的免疫反应；（3）疫苗接种反应。经过系统筛选，分别有35篇、4篇和5篇文章被认为适合各分析领域。尽管本研究纳入的报告存在异质性，但我们发现胃肠道症状在LT受者中很常见。LT人群的结局本身与普通人群相比并不更差，不过免疫抑制治疗需要谨慎管理。虽然不鼓励完全停用治疗，但使用霉酚酸酯（MMF）时需谨慎，建议使用他克莫司（TAC）。尽管关于感染新冠病毒后获得性免疫的数据存在冲突，但疫苗免疫原性似乎较低，这表明该人群的监测水平应保持较高。
