School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Division of Hepatopancreatobiliary Surgery & Abdominal Organ Transplantation, Firoozgar Hospital, Iran University of Medical Sciences, Beh Afarin St., Karim Khan Zand Blvd, Tehran, Iran.
BMC Infect Dis. 2024 Sep 20;24(1):1019. doi: 10.1186/s12879-024-09879-9.
Although liver transplant (LT) recipients are considered a population at risk of severe features of coronavirus disease 2019 (COVID-19), data in this regard are scarce and controversial. In this study, we reported the outcome of 24 cases of LT recipients who were hospitalized due to COVID-19 and investigated the role-playing factors in the severity of the disease.
In this single-center, analytic case-series study, eligible patients were among LT recipients who were hospitalized due to the diagnosis of COVID-19 based on positive results of polymerase chain reaction. Participants were categorized as severe COVID-19 if they were admitted to the intensive care unit, experienced respiratory failure demanding mechanical ventilation, or eventually died. Demographic and clinical data, COVID-19 symptoms and specific treatments, laboratory biomarkers, and immunosuppressive regimens and their alteration during the admission were recorded. Analysis was done using SPSS software.
Twenty-four hospitalized LT patients were included, of which nine had severe and fifteen had non-severe COVID-19. Out of 9 patients with severe COVID-19, four sadly died. The analysis and comparison between the two groups revealed longer hospital stays (P = 0.02), lower lymphocyte counts (P = 0.002), and higher levels of C-reactive protein (CRP) (P = 0.006) in patients with severe COVID-19. Patients with non-severe COVID-19 had higher doses of tacrolimus and mycophenolate in their baseline immunosuppressive regimen (both P = 0.02).
Lymphopenia and high CRP levels are associated with more severe forms of COVID-19 in LT patients. Mycophenolate may have protective properties against severe COVID-19. The role of severity indicators in LT patients with COVID-19 needs to be systematically recognized.
虽然肝移植（LT）受者被认为是患 2019 年冠状病毒病（COVID-19）严重特征的高危人群，但这方面的数据很少且存在争议。在本研究中，我们报告了 24 例因 COVID-19 住院的 LT 受者的结局，并调查了疾病严重程度的相关因素。
在这项单中心、分析性病例系列研究中，合格的患者是基于聚合酶链反应阳性结果而被诊断为 COVID-19 住院的 LT 受者。如果患者被收入重症监护病房、出现需要机械通气的呼吸衰竭或最终死亡，则将其归类为 COVID-19 重症患者。记录了人口统计学和临床数据、COVID-19 症状和具体治疗方法、实验室生物标志物以及住院期间的免疫抑制方案及其改变。使用 SPSS 软件进行分析。
共纳入 24 例住院 LT 患者，其中 9 例为 COVID-19 重症患者，15 例为 COVID-19 非重症患者。在 9 例 COVID-19 重症患者中，有 4 人不幸死亡。对两组患者的分析和比较显示，COVID-19 重症患者的住院时间更长（P=0.02）、淋巴细胞计数更低（P=0.002）和 C 反应蛋白（CRP）水平更高（P=0.006）。COVID-19 非重症患者的基线免疫抑制方案中他克莫司和吗替麦考酚酯的剂量更高（两者 P=0.02）。
淋巴细胞减少和 CRP 水平升高与 LT 患者 COVID-19 更严重的形式有关。吗替麦考酚酯可能对 COVID-19 重症有保护作用。需要系统地认识严重度指标在 LT 患者 COVID-19 中的作用。
