Vachtenheim Jiri, Novysedlak Rene, Svorcova Monika, Lischke Robert, Strizova Zuzana
Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic.
Department of Immunology, Second Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic.
J Clin Med. 2022 Jun 18;11(12):3513. doi: 10.3390/jcm11123513.
Lung transplant (LuTx) recipients are at a higher risk of developing serious illnesses from COVID-19, and thus, we have closely reviewed the consequences of the COVID-19 pandemic on lung transplantation. In most transplant centers, the overall LuTx activity significantly declined and led to a specific period of restricting lung transplantation to urgent cases. Moreover, several transplant centers reported difficulties due to the shortage of ICU capacities. The fear of donor-derived transmission generated extensive screening programs. Nevertheless, reasonable concerns about the unnecessary losses of viable organs were also raised. The overall donor shortage resulted in increased waiting-list mortality, and COVID-19-associated ARDS became an indication of lung transplantation. The impact of specific immunosuppressive agents on the severity of COVID-19 varied. Corticosteroid discontinuation was not found to be beneficial for LuTx patients. Tacrolimus concentrations were reported to increase during the SARS-CoV-2 infection, and in combination with remdesivir, tacrolimus may clinically impact renal functions. Monoclonal antibodies were shown to reduce the risk of hospitalization in SOT recipients. However, understanding the pharmacological interactions between the anti-COVID-19 drugs and the immunosuppressive drugs requires further research.
肺移植（LuTx）受者感染新型冠状病毒肺炎（COVID-19）后罹患严重疾病的风险更高，因此，我们仔细审视了COVID-19大流行对肺移植的影响。在大多数移植中心，肺移植的整体活动显著下降，导致出现了一段将肺移植限制于紧急病例的特定时期。此外，多个移植中心报告称，由于重症监护病房（ICU）容量不足而面临困难。对供体传播的担忧催生了广泛的筛查项目。然而，对于 viable 器官不必要损失的合理担忧也随之而来。供体总体短缺导致等待名单上的死亡率上升，与COVID-19相关的急性呼吸窘迫综合征（ARDS）成为肺移植的一个指征。特定免疫抑制剂对COVID-19严重程度的影响各不相同。未发现停用皮质类固醇对肺移植患者有益。据报道，在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染期间他克莫司浓度会升高，并且与瑞德西韦联用时，他克莫司可能会对肾功能产生临床影响。单克隆抗体已显示可降低实体器官移植（SOT）受者的住院风险。然而，了解抗COVID-19药物与免疫抑制药物之间的药理相互作用还需要进一步研究。
