Wong Germaine, Rowlandson Matthew, Sabanayagam Dharshana, Ginn Andrew N, Kable Kathy, Sciberras Frederika, Au Eric, Draper Jenny, Arnott Alicia, Sintchenko Vitali, Dwyer Dominic E, Chen Sharon C A, Kok Jen
Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.
Centre for Transplant and Renal Research, Westmead Hospital, NSW, Australia.
Transplantation. 2022 Sep 1;106(9):1860-1866. doi: 10.1097/TP.0000000000004203. Epub 2022 Aug 19.
Since November 2021, a new variant of concern (VOC), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage B.1.1.529 (Omicron) has emerged as the dominant coronavirus disease 2019 (COVID-19) infection worldwide. We describe the clinical presentation, risk factors, and outcomes in a cohort of kidney and kidney pancreas transplant recipients with COVID-19 caused by Omicron infection.
We included all kidney and kidney pancreas transplant recipients diagnosed with SARS-CoV-2 Omicron infections between December 26, 2021, and January 14, 2022, in a single transplant center in Australia. Identification of the VOC Omicron was confirmed using phylogenetic analysis of SARS-CoV-2 sequences.
Forty-one patients with kidney (6 living and 33 deceased) and kidney pancreas transplants were diagnosed with the VOC Omicron (lineage B.1.1.529/BA.1) infection during the study period. The mean age (SD) at the time of diagnosis was 52 (11.1) y; 40 (out of 41) (98%) had received at least 2 doses of COVID-19 vaccine. Cough was the most frequent symptom (80.5%), followed by myalgia (70.7%), sore throat (63.4%), and fever (58.5%). After a follow-up time of 30 d, 1 (2.4%) patient died, 2 (4.9%) experienced multiorgan failure, and 5 (12.2%) had respiratory failure; 11 (26.8%) patients developed other superimposed infections. Compared with recipients who did not receive sotrovimab antibody therapy, the odds ratio (95% confidence interval) for hospitalization among patients who received sotrovimab was 0.05 (0.005-0.4).
Despite double or triple dose vaccination, VOC Omicron infections in kidney and kidney pancreas transplant recipients are not necessarily mild. Hospitalization rates remained high (around 56%), and sotrovimab use may prevent hospitalization.
自2021年11月以来，一种新的关注变异株（VOC），即严重急性呼吸综合征冠状病毒2（SARS-CoV-2）谱系B.1.1.529（奥密克戎）已成为全球范围内2019冠状病毒病（COVID-19）感染的主要毒株。我们描述了一组因奥密克戎感染导致COVID-19的肾移植和肾胰联合移植受者的临床表现、危险因素及预后情况。
我们纳入了2021年12月26日至2022年1月14日期间在澳大利亚一个单一移植中心被诊断为感染SARS-CoV-2奥密克戎毒株的所有肾移植和肾胰联合移植受者。通过对SARS-CoV-2序列进行系统发育分析来确认VOC奥密克戎毒株。
在研究期间，41例肾移植（6例活体供肾和33例尸体供肾）和肾胰联合移植受者被诊断为感染VOC奥密克戎毒株（谱系B.1.1.529/BA.1）。诊断时的平均年龄（标准差）为52（11.1）岁；41例中有40例（98%）至少接种了2剂COVID-19疫苗。咳嗽是最常见的症状（80.5%），其次是肌痛（70.7%）、咽痛（63.4%）和发热（58.5%）。经过30天的随访，1例（2.4%）患者死亡，2例（4.9%）发生多器官功能衰竭，5例（12.2%）出现呼吸衰竭；11例（26.8%）患者发生了其他叠加感染。与未接受索托维单抗抗体治疗的受者相比，接受索托维单抗治疗的患者住院的优势比（95%置信区间）为0.05（0.005 - 0.4）。
尽管接种了两剂或三剂疫苗，但肾移植和肾胰联合移植受者感染VOC奥密克戎毒株后的病情不一定较轻。住院率仍然很高（约56%），使用索托维单抗可能预防住院。
