Loinaz-Segurola Carmelo, Marcacuzco-Quinto Alberto, Fernández-Ruiz Mario
HBP and Transplant Surgery Unit. Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain.
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid 28041, Spain.
World J Hepatol. 2021 Oct 27;13(10):1299-1315. doi: 10.4254/wjh.v13.i10.1299.
The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted liver transplant (LT) activity across the world, with notable decreases in the number of donations and procedures in most Western countries, in particular throughout the first wave. The cumulative incidence of COVID-19 in LT recipients (with estimates ranging from 0.34% to 1.56%) appears to be at least comparable to that observed for the general population. Clinical and radiological features at presentation are also similar to non-transplant patients. The risk of death among LT recipients requiring hospital admission is high (from 12% to 19%), although some authors have suggested that overall mortality may be actually lower compared to the general non-transplant population. It is likely that these poor outcomes may be mainly influenced by the older age and higher comorbidity burden of LT recipients, rather than by the transplant status itself. In fact, it has been hypothesized that post-transplant immunosuppression would exert a protective role, with special focus on tacrolimus-containing regimens. There is scarce evidence to guide the optimal management of post-transplant COVID-19 and the use of antiviral or immunomodulatory therapies, although both clinical practice and guidelines support the dose reduction or withdrawal of anti-proliferative agents such as mofetil mycophenolate. Preliminary reports suggest that the antibody response to messenger RNA vaccines is significantly impaired as compared to non-immunocompromised individuals, in line with other transplant populations. Finally, it is foreseeable that the future will be conditioned by the emerging variants of severe acute respiratory syndrome coronavirus 2 with increased transmissibility among LT recipients.
2019年冠状病毒病（COVID-19）大流行对全球肝移植（LT）活动产生了深远影响，大多数西方国家的捐赠数量和手术数量显著减少，尤其是在第一波疫情期间。肝移植受者中COVID-19的累积发病率（估计范围为0.34%至1.56%）似乎至少与普通人群中观察到的发病率相当。发病时的临床和放射学特征也与非移植患者相似。需要住院治疗的肝移植受者的死亡风险很高（从12%到19%），尽管一些作者认为，与普通非移植人群相比，总体死亡率可能实际上更低。这些不良结果可能主要受肝移植受者年龄较大和合并症负担较高的影响，而不是受移植状态本身的影响。事实上，有人推测移植后的免疫抑制会发挥保护作用，特别关注含他克莫司的治疗方案。尽管临床实践和指南都支持减少或停用抗增殖药物，如霉酚酸酯，但几乎没有证据指导移植后COVID-19的最佳管理以及抗病毒或免疫调节疗法的使用。初步报告表明，与非免疫功能低下个体相比，信使核糖核酸疫苗的抗体反应明显受损，这与其他移植人群一致。最后，可以预见，未来将受到严重急性呼吸综合征冠状病毒2新出现的变异株的影响，这些变异株在肝移植受者中的传播性增加。
