Marbun Maruhum Bonar H, Saragih Riahdo J, Andina Tantika
Division of Nephrology and Hypertension, Department of Internal Medicine, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Int J Nephrol. 2022 Aug 18;2022:9636624. doi: 10.1155/2022/9636624. eCollection 2022.
Kidney transplant recipients (KTRs) were reported to be at higher risk of developing severe coronavirus disease-2019 (COVID-19). Despite being one of the most impacted countries, little is known about KTRs with COVID-19 in Indonesia. This report aims to explore the management strategies and short-term clinical outcomes of KTRs with COVID-19 in an Indonesian transplant center.
We observed KTRs who were admitted following COVID-19 diagnosis. Anamnesis, physical, laboratory, and radiologic examinations were performed. Demographic and transplant histories were recorded, along with symptoms, vaccination status, and management related to COVID-19.
Nineteen KTRs were observed and 14 (73.6%) were male. The most common presenting symptoms were fever, cough, and shortness of breath. Nine (47.3%) KTRs had severe-critical COVID-19. The mortality rate was 42.1%. Acute kidney injury (AKI) was present in six (31.6%) of KTRs, five (83.3%) of whom were nonsurvivors. The median D-dimer level was higher in nonsurvivors (5,800 versus 670 L), while other laboratory parameters were comparable. Seven (36.8%) KTRs were vaccinated. The mortality rates of vaccinated and unvaccinated KTRs were 14.2% and 70%, respectively. Antiviral therapy, anticoagulant, intravenous immunoglobulin, and tocilizumab were prescribed to 89.5%, 89.5%, 15.8%, and 10.5%, respectively. Immunosuppressive therapy (IST) was halted in 68% of KTRs, among which 61.5% passed away.
The clinical presentation of COVID-19 in KTRs was similar to that in the general population, whereas the mortality rate was higher. Management strategies for KTRs with COVID-19 should include prevention of AKI and hypercoagulation. Vaccination seems to be beneficial for KTRs, while temporary withdrawal of IST does not.
据报道，肾移植受者（KTRs）感染严重的2019冠状病毒病（COVID-19）的风险更高。尽管印度尼西亚是受影响最严重的国家之一，但对于该国感染COVID-19的肾移植受者却知之甚少。本报告旨在探讨印度尼西亚一家移植中心中感染COVID-19的肾移植受者的管理策略和短期临床结局。
我们观察了COVID-19诊断后入院的肾移植受者。进行了问诊、体格检查、实验室检查和影像学检查。记录了人口统计学和移植病史，以及症状、疫苗接种状况和与COVID-19相关的管理情况。
观察了19例肾移植受者，其中14例（73.6%）为男性。最常见的症状是发热、咳嗽和呼吸急促。9例（47.3%）肾移植受者患有重症/危重症COVID-19。死亡率为42.1%。6例（31.6%）肾移植受者出现急性肾损伤（AKI），其中5例（83.3%）死亡。非幸存者的D-二聚体水平中位数更高（5800对670μg/L），而其他实验室参数相当。7例（36.8%）肾移植受者接种了疫苗。接种疫苗和未接种疫苗的肾移植受者的死亡率分别为14.2%和70%。分别有89.5%、89.5%、15.8%和10.5%的患者接受了抗病毒治疗、抗凝治疗、静脉注射免疫球蛋白和托珠单抗治疗。68%的肾移植受者停止了免疫抑制治疗（IST），其中61.5%死亡。
肾移植受者感染COVID-19的临床表现与普通人群相似，但死亡率更高。感染COVID-19的肾移植受者的管理策略应包括预防急性肾损伤和高凝状态。疫苗接种似乎对肾移植受者有益，而暂时停用免疫抑制治疗则不然。
