Wijayaratne Dilushi, Chandrasiri Suwan, Gunaratne Preeni, Wijewickrama Eranga
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
University Medical Unit, National Hospital of Sri Lanka, Sri Lanka.
Indian J Nephrol. 2023 May-Jun;33(3):202-205. doi: 10.4103/ijn.ijn_508_21. Epub 2023 Mar 8.
Coronavirus disease 2019 (COVID-19) causes severe illness in the immunocompromised. This study aimed to describe the severity and outcomes of kidney transplant recipients (KTRs) treated for COVID-19 during the first 16 months of the pandemic in Sri Lanka. We conducted a cross-sectional survey of all nephrology centers in Sri Lanka using a self-administered electronic data collection sheet. All practicing nephrologists were invited. KTRs who had been treated/were under treatment for COVID-19 between March 1, 2020 and June 30, 2021 were included. Data on patient demographics, management practices, and outcomes were collected. Outcomes included graft loss, requirement of kidney replacement therapy (KRT), duration of hospital stay, highest level of treatment setting, highest level of respiratory support, and mortality. Fifteen nephrologists (12 centers) responded with data regarding 58 KTRs with COVID-19, 10 of whom were receiving ongoing treatment; 47/58 (81%) were male. Forty (69%) were between 30 and 59 years of age and 15 (25.9%) were aged 60 years or above. Fourteen (24.1%) were within 1 year of transplantation. Fifty-three (91.4%) were on triple immunosuppression. Antiproliferative was reduced/withheld in 89.1% and calcineurin inhibitor was reduced/withheld in 42.1%. Overall mortality was 16/48 (33.3%). Seventeen (29.3%) required intensive care. Six (10.3%) received noninvasive ventilation, and 11 (19.0%) received invasive ventilation. Ten of the ventilated patients died. Six needed acute KRT, five of whom died. One patient survived with a loss of graft. There was no association between modifications to the immunosuppression and outcomes. COVID-19 causes poor outcomes and severe illness in KTRs. Special preventive and therapeutic strategies are urgently required.
2019冠状病毒病（COVID-19）可导致免疫功能低下者患上重症。本研究旨在描述在斯里兰卡疫情的前16个月中接受COVID-19治疗的肾移植受者（KTR）的病情严重程度和结局。我们使用自行管理的电子数据收集表对斯里兰卡所有肾脏病中心进行了横断面调查。邀请了所有执业肾脏病专家。纳入了2020年3月1日至2021年6月30日期间接受过COVID-19治疗/正在接受治疗的KTR。收集了患者人口统计学、管理措施和结局的数据。结局包括移植物丢失、肾脏替代治疗（KRT）需求、住院时间、最高治疗级别、最高呼吸支持级别和死亡率。15名肾脏病专家（12个中心）提供了58例COVID-19 KTR的数据，其中10例正在接受治疗；47/58（81%）为男性。40例（69%）年龄在30至59岁之间，15例（25.9%）年龄在60岁及以上。14例（24.1%）在移植后1年内。53例（91.4%）接受三联免疫抑制治疗。89.1%的患者抗增殖药物减少/停用，42.1%的患者钙调神经磷酸酶抑制剂减少/停用。总死亡率为16/48（33.3%）。17例（29.3%）需要重症监护。6例（10.3%）接受无创通气，11例（19.0%）接受创通气。10例接受通气的患者死亡。6例需要急性KRT，其中5例死亡。1例患者移植失败但存活。免疫抑制调整与结局之间无关联。COVID-19在KTR中导致不良结局和重症。迫切需要特殊的预防和治疗策略。
