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一名怀孕肾移植受者的新型冠状病毒肺炎——我们需要了解的情况:病例报告

COVID-19 in a pregnant kidney transplant recipient - what we need to know: A case report.

作者信息

Angelico Roberta, Framarino-Dei-Malatesta Maria Luisa, Iaria Giuseppe

机构信息

Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome 00100, Italy.

Department of Gynecologic-Obstetrical and Urologic Sciences, Policlinico Umbero I, Sapienza University of Rome, Rome 00100, Italy.

出版信息

World J Transplant. 2022 Oct 18;12(10):325-330. doi: 10.5500/wjt.v12.i10.325.

Abstract

BACKGROUND

In the era of the coronavirus disease 2019 (COVID-19) pandemic, kidney tran splant recipients are more susceptible to severe acute respiratory syndrome co ronavirus (SARS-CoV-2) infection, developing severe morbidity and graft im pairment. Pregnant women are also more likely to develop severe COVID-19 di sease, causing pregnancy complications such as preterm births and acute kidney injury.

CASE SUMMARY

Herein, we report the case of a pregnant woman with a third kidney tran splantation who developed COVID-19 disease. The reduction of immunosuppressive drugs and strict monitoring of trough blood levels were needed to avoid severe SARS-CoV-2-related complications, and permitted to continue a healthy pregnancy and maintain good graft function. In such a complex scenario, the con comitance of COVID-19-related morbidity, the risk of acute rejection in the hype rimmune recipient, graft dysfunction and pregnancy complications make the management of immunosuppression a very difficult task and clinicians must be aware.

CONCLUSION

Tailoring the immunosuppressive regimen is a key factor affecting both the graft outcome and pregnancy safety.

摘要

背景

在2019冠状病毒病(COVID-19)大流行时代,肾移植受者更容易感染严重急性呼吸综合征冠状病毒(SARS-CoV-2),出现严重发病情况和移植肾功能损害。孕妇也更易患重症COVID-19疾病,导致早产和急性肾损伤等妊娠并发症。

病例摘要

在此,我们报告一例接受第三次肾移植的孕妇发生COVID-19疾病的病例。需要减少免疫抑制药物用量并严格监测血药谷浓度,以避免发生与SARS-CoV-2相关的严重并发症,从而得以继续健康妊娠并维持良好的移植肾功能。在如此复杂的情况下,COVID-19相关发病情况、高免疫反应受者发生急性排斥反应的风险、移植肾功能障碍和妊娠并发症并存,使得免疫抑制管理成为一项非常艰巨的任务,临床医生必须予以关注。

结论

调整免疫抑制方案是影响移植肾结局和妊娠安全的关键因素。

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COVID-19 infection in pregnancy: a review of existing knowledge.妊娠期新冠病毒感染:现有知识综述
Horm Mol Biol Clin Investig. 2022 Feb 16;43(3):373-378. doi: 10.1515/hmbci-2021-0081. eCollection 2022 Sep 1.
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SARS-CoV-2 evolution during treatment of chronic infection.慢性感染治疗过程中 SARS-CoV-2 的进化。
Nature. 2021 Apr;592(7853):277-282. doi: 10.1038/s41586-021-03291-y. Epub 2021 Feb 5.

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