Tatapudi Ravi Raju, Kopparti Venkateswara Rao, Poosapati Anusha, Metta Srinivas, Gongada Atchyutha Rao, Vedulla Balakrishna
Apollo Hospitals, Health City, Arilova, Chinagadali, Visakhapatnam, Andhra Pradesh 530040, India.
GITAM Institute of Medical Sciences and Research, Rushikonda, Visakhapatnam, Andhra Pradesh 530045, India.
Int J Nephrol. 2021 Nov 5;2021:2243095. doi: 10.1155/2021/2243095. eCollection 2021.
The second wave of COVID-19 has spread across India causing unprecedented misery to people since March 2021. Kidney transplant recipients (KTRs) are at an increased risk of severe infection. Their outcomes appear to be worse than those in the general population. There is no robust evidence or consensus to support any form of treatment protocol or modification of immunosuppression in KTRs with COVID-19. There is a need to develop effective and safe therapeutic protocols for this frail population. Remdesivir is the only approved antiviral drug in COVID-19 till now.
We describe clinical features, role of HRCT, therapeutic protocols, and mortality rate of 20 KTRs with SARS-CoV-2 infection.
Complete recovery was seen in 8 (40%) patients monitored at home. 12 (60%) patients with HRCT scores more than 8/25 were hospitalized. 11 (55%) had hypoxia, of these 8 (40%) had mild hypoxia, 1 (5%) required NIV, and 2 (10%) needed mechanical ventilation. Immunosuppression was modified in all the patients. Remdesivir and dexamethasone were administered to the hospitalized patients. 1 (5%) patient had AKI requiring RRT. 1 (5%) patient expired, and 1 still hospitalized. 10 of the hospitalized patients recovered. Out of the total 20 patients, 18 (90%) recovered completely within two weeks of infection.
Clinical presentation of COVID-19 in KTRs was similar to nontransplant patients. Early hospitalisation and assessing the severity by HRCT were important. Continuing tacrolimus and administering remdesivir and dexamethasone reduced the incidence of renal failure and improved survival rates.
自2021年3月以来，新冠疫情的第二波浪潮席卷印度，给民众带来了前所未有的苦难。肾移植受者（KTRs）发生严重感染的风险增加。他们的预后似乎比普通人群更差。对于感染新冠病毒的肾移植受者，没有有力的证据或共识支持任何形式的治疗方案或免疫抑制调整。有必要为这一脆弱人群制定有效且安全的治疗方案。瑞德西韦是目前新冠疫情中唯一获批的抗病毒药物。
我们描述了20例感染新冠病毒的肾移植受者的临床特征、HRCT的作用、治疗方案及死亡率。
8例（40%）在家监测的患者完全康复。12例（60%）HRCT评分超过8/25的患者住院治疗。11例（55%）出现低氧血症，其中8例（40%）为轻度低氧血症，1例（5%）需要无创通气，2例（10%）需要机械通气。所有患者均调整了免疫抑制。住院患者接受了瑞德西韦和地塞米松治疗。1例（5%）患者发生急性肾损伤需要进行肾脏替代治疗。1例（5%）患者死亡，1例仍住院。10例住院患者康复。在全部20例患者中，18例（90%）在感染后两周内完全康复。
肾移植受者感染新冠病毒后的临床表现与非移植患者相似。早期住院并通过HRCT评估病情严重程度很重要。继续使用他克莫司并给予瑞德西韦和地塞米松可降低肾衰竭发生率并提高生存率。
