Caillard Sophie
Service de néphrologie et transplantation, hôpitaux universitaires de Strasbourg, Strasbourg, France.
Bull Acad Natl Med. 2022 Apr;206(4):511-517. doi: 10.1016/j.banm.2022.01.025. Epub 2022 Feb 16.
The Covid-19 pandemic hit the transplant world in March 2020. Teams quickly organized themselves to optimize the management of their immunocompromised patients and to progress in the knowledge of this new disease. To do this, a French Registry was set up, listing all solid organ transplant patients who had developed a SARS Cov2 infection. Numerous studies carried out on the basis of these data have enabled us to describe the disease in transplant patients, to characterize its clinical and biological severity factors and to define its prognosis. The mortality of transplant patients hospitalized for Covid-19 is 23% at 60 days and renal insufficiency plays a major role in the poor prognosis in addition to the classic risk factors described in the general population. The advent of vaccination has been a great relief, but transplant patients have developed a poorer vaccine response than immunocompetent subjects, keeping them at risk of severe disease after an adapted vaccination schedule. Specific strategies had to be adopted in this particularly fragile population (increased number of vaccine doses, injection of monoclonal antibodies). The collaboration of the French transplantation centers under the impulse of the allowed us to carry out many collaborative projects, which were of great use for the care of the patients.
2020年3月,新冠疫情冲击了移植领域。各团队迅速组织起来,优化对免疫功能低下患者的管理,并增进对这种新疾病的了解。为此,法国建立了一个登记处,列出了所有感染了SARS-CoV-2的实体器官移植患者。基于这些数据开展的大量研究使我们能够描述移植患者中的这种疾病,确定其临床和生物学严重程度因素,并明确其预后。因新冠住院的移植患者60天死亡率为23%,除了普通人群中描述的经典风险因素外,肾功能不全在不良预后中起主要作用。疫苗接种的出现带来了极大的缓解,但移植患者的疫苗反应比免疫功能正常的受试者差,在采用适应性疫苗接种方案后,他们仍有患重症的风险。必须在这个特别脆弱的人群中采取特定策略(增加疫苗剂量、注射单克隆抗体)。在法国移植中心的推动下,各中心开展了许多合作项目,这些项目对患者的治疗非常有用。