Practical recommendations for kidney transplantation in the COVID-19 pandemic.
Practical recommendations for kidney transplantation in the COVID-19 pandemic.
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DOI：
10.5500/wjt.v10.i9.223
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发表时间：
2020-09-18
期刊：
影响因子：
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通讯作者：
Khalaileh A
中科院分区：
文献类型：
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作者：
Imam A;Tzukert K;Merhav H;Imam R;Abu-Gazala S;Abel R;Elhalel MD;Khalaileh A
全球病毒大流行期间的肾移植在许多方面都变得充满挑战。首先，我们必须重新评估已故捐赠者（对于接受者）的安全，特别是在冠状病毒病 19 (COVID-19) 发病率相对较高的社区。对于选择性活体捐献者，如果决定这样做，则必须做出类似的考虑，这可能会给捐献者带来过度的困难。受体选择也存在问题，因为有明确证据表明，60 岁以上患者以及患有高血压、糖尿病、肥胖和肺部疾病等合并症的患者因 COVID-19 发病率和死亡率要高得多。不幸的是，许多（如果不是大多数）透析患者都符合这种模式。我们可以而且确实必须重新评估我们的分配政策，但这必须基于数据而不是猜测。必须重新设计后续程序，以尽量减少患者的旅行和接触。对技术和远程医疗的依赖至关重要。向患者提供这项技术极其重要。修改或改变免疫抑制方案是有争议的，并且不是基于临床研究。尽管如此，我们应该重新评估普通患者全面诱导治疗的必要性，以及在已证实感染的移植患者中更自由地使用哺乳动物靶点雷帕霉素抑制剂。
Kidney transplantation at the time of a global viral pandemic has become challenging in many aspects. Firstly, we must reassess deceased donor safety (for the recipient) especially in communities with a relatively high incidence of coronavirus disease 19 (COVID-19). With respect to elective live donors, if one decides to do them at all, similar considerations must be made that may impose undue hardship on the donor. Recipient selection is also problematic since there is clear evidence of a much higher morbidity and mortality from COVID-19 for patients older than 60 and those with comorbidities such as hypertension, diabetes, obesity and lung disease. Unfortunately, many, if not most of dialysis patients fit that mold. We may and indeed must reassess our allocation policies, but this must be done based on data rather than conjecture. Follow-up routines must be re-engineered to minimize patient travel and exposure. Reliance on technology and telemedicine is paramount. Making this technology available to patients is extremely important. Modifying or changing immunosuppression protocols is controversial and not based on clinical studies. Nevertheless, we should reassess the need for induction therapy across the board for ordinary patients and the more liberal use of mammalian target of rapamycin inhibitors in transplant patients with proven infection.