Jacq Amélie, Auvray Christelle, Blot Mathieu, Bouhemad Belaïd, Casenaz Alice, Lamarthée Baptiste, Legendre Mathieu, Quenot Jean-Pierre, Zanetta Gilbert, Tinel Claire
Department of Nephrology and Kidney Transplantation, Dijon University Hospital, Dijon, France.
Department of Virology, Dijon University Hospital, Dijon, France.
Front Transplant. 2024 Mar 12;3:1305152. doi: 10.3389/frtra.2024.1305152. eCollection 2024.
Coronavirus disease 2019 (COVID-19) poses an important risk of morbidity and of mortality, in patients after solid organ transplantation. Recommendations have been issued by various transplantation societies at the national and European level to manage the immunosuppressive (IS) regimen upon admission to intensive care unit (ICU).
The aim of this study was to evaluate the adequacy of IS regimen minimization strategy in kidney transplant recipients hospitalized in an ICU for severe COVID-19, in relation to the issued recommendations.
The immunosuppressive therapy was minimized in all patients, with respectively 63% and 59% of the patients meeting the local and european recommendations upon admission. During ICU stay, IS was further tapered leading to 85% (local) and 78% (european) adequacy, relative to the guidelines. The most frequent deviation was the lack of complete withdrawal of mycophenolic acid (22%). Nevertheless, the adequacy/inadequacy status was not associated to the ICU- or one-year-mortality.
In this single-center cohort, the only variable associated with a reduction in mortality was vaccination, emphasizing that the key issue is immunization prior to infection, not restoration of immunity during ICU stay.
2019年冠状病毒病（COVID-19）对实体器官移植术后患者构成了重要的发病和死亡风险。国家和欧洲层面的多个移植学会已发布建议，以指导在重症监护病房（ICU）收治时免疫抑制（IS）方案的管理。
本研究的目的是评估在因重症COVID-19入住ICU的肾移植受者中，IS方案最小化策略与已发布建议的符合程度。
所有患者的免疫抑制治疗均降至最低，分别有63%和59%的患者在入院时符合当地和欧洲的建议。在ICU住院期间，IS进一步减量，相对于指南，分别有85%（当地）和78%（欧洲）符合要求。最常见的偏差是未完全停用霉酚酸（22%）。然而，符合/不符合要求的状态与ICU死亡率或一年死亡率无关。
在这个单中心队列中，与死亡率降低相关的唯一变量是疫苗接种，这强调关键问题是感染前的免疫接种，而非ICU住院期间免疫功能的恢复。
