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感染新型冠状病毒肺炎的肝移植受者的诊断、治疗方案及预后

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19.

作者信息

Hashem Mai, El-Kassas Mohamed

机构信息

Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt.

Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt.

出版信息

World J Clin Cases. 2023 Apr 6;11(10):2140-2159. doi: 10.12998/wjcc.v11.i10.2140.

Abstract

Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.

摘要

2019年11月的几例致命肺炎最初与严重急性呼吸综合征冠状病毒2有关,世界卫生组织后来将其指定为冠状病毒病2019(COVID-19)。2020年3月11日,世界卫生组织宣布COVID-19为大流行病。在一般人群中,COVID-19的严重程度可从无症状/轻微症状到重症。其死亡率可能高达49%。疾病控制与预防中心承认,患有特定基础疾病的人群,包括实体器官移植(SOT)后需要免疫抑制的人群,感染COVID-19后发展为重症的风险增加。肝移植是全球第二常见的实体器官移植。由于肝移植(LT)受者处于免疫抑制状态,他们更容易发生严重感染。因此,实体器官移植受者的合并症和长期免疫抑制增加了发生重症COVID-19的可能性。了解COVID-19感染的临床表现、免疫抑制管理、预后和预防至关重要,因为它可能对移植受者构成危险。这篇综述描述了肝移植受者中COVID-19的临床和实验室检查结果以及该人群中重症疾病的危险因素。在以下各节中,我们讨论了当前COVID-19的治疗选择,回顾了调整免疫抑制剂方案的标准做法,并概述了目前已获许可药物用于住院和门诊管理的安全性和有效性。此外,我们探讨了肝移植受者中COVID-19的临床结局,并提及了疫苗接种的有效性和安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a74/10131019/e5b1b1128a97/WJCC-11-2140-g001.jpg

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