Angelico Roberta, Framarino-Dei-Malatesta Maria Luisa, Iaria Giuseppe
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.
World J Transplant. 2022 Oct 18;12(10):325-330. doi: 10.5500/wjt.v12.i10.325.
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.
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.
Tailoring the immunosuppressive regimen is a key factor affecting both the graft outcome and pregnancy safety.
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。
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。
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。
