活体肝移植受者中的 COVID-19：结局更差还是相当？
Covid-19 in recipients of living donor liver transplantation: a worse or an equivalent outcome?
机构信息
Tropical Medicine Department, Ain Shams University, Cairo, Egypt.
Hepatobiliary Unit, Surgical Department, Ain Shams University, Cairo, Egypt.
出版信息
QJM. 2022 Feb 21;115(2):69-76. doi: 10.1093/qjmed/hcab329.
BACKGROUND
Coronavirus disease 2019 (Covid-19) pandemic is representing a massive burden to the community with the new virus. There is few data regarding Covid-19 in liver transplant patients. Concerns were raised regarding the course of the disease in transplanted patients due to immunosuppression and risk of hepatic injuries.
AIM
To describe the outcomes of Covid-19 infection in recipients of living-donor liver transplantation (LDLT).
METHODS
Retrospective analysis of 41 recipients of LDLT diagnosed with Covid-19 by real-time PCR or CT chest criteria of Covid-19 between April 2020 and April 2021. This Cohort was derived from Ain Shams Center for Organ Transplantation database, Ain Shams Specialized Hospital, Cairo, Egypt, which is considered one of the largest centers of LDLT in the Middle East. Patients were classified to mild, moderate, severe and critics according to clinical classification released by the National Health Commission of China.
RESULTS
A total of 41 patients and 2 patients with reinfection were included in this cohort with mean age 54 years with 74% male and 26% female. The body mass index ranged from 19.3 to 37. About 30% were described as a mild case, 46.5% were moderate, 14% were severe and 9% were critical cases. Two cases developed infection twice. Total of 20 patients (46.5%) were managed in home isolation setting, 17 patients (39.5%) needed admission to ward, 4 patients (9%) in intermediate care unit and 2 patients (4%) admitted to intensive care unit. About 60% of cases were on room air, only 3 patients needed invasive methods, 2 patients needed face mask and 1 case needed invasive CPAP. In total, 41 patients recovered (95%) and 2 patients (5%) died; 1 was Covid related and the other one was non-Covid related. Female gender, higher BMI and hypertension were associated with severe course of the disease.
CONCLUSION
In the setting of LDLT, the possibilities of catching Covid-19 infection are high due to chronic immunosuppression use. Yet, the outcome of infection in term of morbidity and the needs for hospital admission or intensive care is generally matched to general population.
背景
新型冠状病毒（COVID-19）大流行给社区带来了巨大的负担。关于肝移植患者的 COVID-19 数据很少。由于免疫抑制和肝损伤的风险，人们对移植患者疾病的病程表示担忧。
目的
描述活体肝移植（LDLT）受者感染 COVID-19 的结果。
方法
回顾性分析 2020 年 4 月至 2021 年 4 月期间通过实时 PCR 或胸部 CT 标准诊断为 COVID-19 的 41 例 LDLT 受者。该队列源自埃及开罗艾因沙姆斯专科医院的艾因沙姆斯器官移植中心数据库，该中心被认为是中东最大的 LDLT 中心之一。根据中国国家卫生健康委员会发布的临床分类，患者被分为轻症、中度、重症和危重症。
结果
本研究共纳入 41 例患者和 2 例再感染患者，平均年龄 54 岁，男性占 74%，女性占 26%。体重指数范围为 19.3 至 37。约 30%的患者为轻症，46.5%为中度，14%为重症，9%为危重症。有 2 例患者发生了 2 次感染。20 例（46.5%）患者在家中隔离治疗，17 例（39.5%）患者需要住院治疗，4 例（9%）患者需要在中级护理病房治疗，2 例（4%）患者需要在重症监护病房治疗。约 60%的患者使用室内空气，仅 3 例患者需要侵入性方法，2 例患者需要面罩，1 例患者需要侵入性 CPAP。共有 41 例患者康复（95%），2 例患者（5%）死亡；1 例与 COVID-19 相关，另 1 例与 COVID-19 无关。女性、较高的 BMI 和高血压与疾病的严重程度有关。
结论
在 LDLT 中，由于长期使用免疫抑制剂，感染 COVID-19 的可能性很高。然而，就发病率和住院或重症监护的需求而言，感染的结果通常与一般人群相匹配。
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