Gastroenterology Unit, University Hospital Policlinico of Bari, Bari, Italy.
Gastroenterology Unit, Department of Precision and Regenerative Medicine - Ionian Area-, University of Bari Aldo Moro, Bari, Italy.
Front Immunol. 2023 Jul 3;14:1203854. doi: 10.3389/fimmu.2023.1203854. eCollection 2023.
The study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators.
Case collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate.
Among the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP.
According to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.
研究 SARS-CoV-2 感染在不同实体器官移植环境中的免疫反应，为阐明 SARS-CoV-2 与免疫系统之间的相互作用提供了机会。在我们来自意大利的全国性注册研究中，我们特别评估了在第一波大流行期间，即未接种疫苗的患者中，肝移植受者（LTR）中 COVID-19 感染、死亡率和病死率的流行情况，使用非肝实体器官移植受者（NL-SOTR）和意大利普通人群（GP）作为对照。
病例收集始于 2020 年 2 月 21 日至 6 月 22 日，使用国家卫生研究所和国家移植中心的数据，而数据分析于 2020 年 9 月 30 日进行。为了比较 LTR、NL-SOTR 和意大利 GP 中感染、死亡率和病死率的性别和年龄调整分布，我们应用间接标准化方法来确定标准化率。
在 43983 名意大利有功能移植物的 SOTR 中，LTR 占 14168 名患者，其中 89 名 SARS-CoV-2 感染。在 29815 名 NL-SOTR 中，观察到 361 例 SARS-CoV-2 感染。该疾病的地理分布在意大利不同地区差异很大。LTR 的感染、死亡率和病死率标准化率低于 NL-SOTR[1.02（95%CI 0.81-1.23）比 2.01（95%CI 1.8-2.2）；1.0（95%CI 0.5-1.5）比 4.5（95%CI 3.6-5.3）；1.6（95%CI 0.7-2.4）比 2.8（95%CI 2.2-3.3）]，与意大利 GP 相当。
根据最近关于 SOTR 和 SARS-CoV-2 感染的研究，我们的数据强烈表明，与接受类似免疫抑制治疗的 NL-SOTR 观察到的情况相反，LTR 感染 SARS-CoV-2 的风险、死亡率和病死率与普通人群相同。这些结果表明 LTRS 对 SARS-CoV-2 感染的免疫反应与 NL-SOTR 不同，可能与移植物肝脏诱导免疫耐受的能力有关。
