Immunosuppressants in Liver Transplant Recipients With Coronavirus Disease 2019: Capability or Catastrophe?-A Systematic Review and Meta-Analysis.
Immunosuppressants in Liver Transplant Recipients With Coronavirus Disease 2019: Capability or Catastrophe?-A Systematic Review and Meta-Analysis.
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患有 2019 年冠状病毒病的肝移植受者中的免疫抑制剂：能力还是灾难？ - 系统回顾和荟萃分析
DOI：
10.3389/fmed.2021.756922
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发表时间：
2021
影响因子：
3.9
通讯作者：
Liang T
中科院分区：
文献类型：
--
作者：
Yadav DK;Adhikari VP;Ling Q;Liang T
背景：维持性免疫抑制剂 (IS) 对患有 2019 年冠状病毒病 (COVID-19) 的肝移植 (LT) 受者的可能影响仍有待探索。我们的具体目标是在标准维持 IS 上估计患有 COVID-19 的 LT 接受者的预后。方法：我们在不同的数据库中检索了2019年12月至2021年6月25日期间合格的研究。最终，使用基于异质性的固定效应或随机效应模型进行荟萃分析。结果：在总共 8 项研究和 509 名患有 COVID-19 的 LT 接受者中，所有联合免疫抑制治疗期间的合并严重程度和死亡率分别为 22.4% 和 19.5%。我们的研究充分表明，患有 COVID-19 的 LT 接受者接受免疫抑制治疗与非重症 COVID-19 显着相关[比值比 (OR)：11.49，95% CI：4.17–31.65； p < 0.001] 和患者的生存率（OR：17.64，95% CI：12.85–24.22；p < 0.001）。此外，与钙调神经磷酸酶抑制剂 (CNI)、类固醇和抗代谢药物等其他 IS 相比，哺乳动物雷帕霉素靶点抑制剂 (mTORi) 的严重程度和死亡率通常最低，即严重程度（13.5 vs. 21.1、24.7 和 26.3%）和死亡率（8.3 vs. 15、17.2 和 12.1%），分别。与一般观点相反，我们的荟萃分析显示，糖尿病、高血压、心肺疾病、慢性肾病 (CKD)、年龄 >60 岁、LT 到诊断出 COVID-19 的持续时间、LT 的原发疾病和肥胖等合并症与接受免疫抑制治疗的 COVID-19 LT 接受者的严重程度和死亡率没有显着相关性。然而，我们的汇总分析发现，与同时患有 COVID-19 和合并症的患者相比，患有 COVID-19 且没有合并症的 LT 接受者病情较轻且死亡率较低。结论：总而言之，接受免疫抑制治疗的 COVID-19 LT 受者与严重程度和死亡率没有显着相关性。因此，如果重点考虑器官排斥的风险，完全退出IS可能并不明智。然而，在某些选定的患有 COVID-19 的 LT 接受者中，根据疾病的严重程度，可能会停止使用吗替麦考酚酯 (MMF) 或将其替换为基于 CNIs 或 mTORis 的免疫抑制治疗。
Background: The probable impact of a maintenance immunosuppressant (IS) on liver transplant (LT) recipients with coronavirus disease 2019 (COVID-19) remains unexplored. Our specific aim was to approximate the prognosis of LT recipients with COVID-19 on the standard maintenance IS. Method: We searched separate databases for the qualified studies in between December 2019 and June 25, 2021. Ultimately, a meta-analysis was carried out using a fixed-effect or random-effect model based on the heterogeneity. Results: In a total of eight studies and 509 LT recipients with COVID-19, the pooled rates of severity and mortality during all the combined immunosuppressive therapies were 22.4 and 19.5%, respectively. Our study sufficiently showed that an immunosuppressive therapy in LT recipients with COVID-19 was significantly associated with a non-severe COVID-19 [odds ratio (OR): 11.49, 95% CI: 4.17–31.65; p < 0.001] and the survival of the patients (OR: 17.64, 95% CI: 12.85–24.22; p < 0.001). Moreover, mammalian target of rapamycin inhibitor (mTORi) typically had the lowest rate of severity and mortality compared to other ISs such as calcineurin inhibitors (CNIs), steroids, and antimetabolites, i.e., severity (13.5 vs. 21.1, 24.7, and 26.3%) and mortality (8.3 vs. 15, 17.2, and 12.1%), respectively. Contrary to the general opinions, our meta-analysis showed comorbidities such as diabetes, hypertension, cardiopulmonary disorders, chronic kidney disease (CKD), age >60, the duration of LT to the diagnosis of COVID-19, primary disease for LT, and obesity were not significantly associated with the severity and mortality in LT recipients with COVID-19 under an immunosuppressive therapy. However, our pooled analysis found that LT recipients with COVID-19 and without comorbidities have a less severe disease and low mortality rate compared to those with both COVID-19 and comorbidities. Conclusions: In conclusion, LT recipients with COVID-19 undergoing immunosuppressive therapies are not significantly associated with the severity and mortality. Therefore, taking the risk of organ rejection into a key consideration, a complete withdrawal of the IS may not be wise. However, mycophenolate mofetil (MMF) might be discontinued or replaced from an immunosuppressive regimen with the CNIs- or mTORis-based immunosuppressive therapy in some selected LT recipients with COVID-19, depending upon the severity of the disease.
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DOI：
10.1016/j.cmi.2020.07.016
发表时间：
2020-12
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Westwood D;MacFadden DR;Soucy JR;Daneman N
通讯作者：
Daneman N
影响因子：
2.1
作者：
Boddana, Preetham;Webb, Lynsey H.;Harper, Steven J.
通讯作者：
Harper, Steven J.
影响因子：
7.8
作者：
De Francesco MA;Alberici F;Bossini N;Scolari F;Pascucci F;Tomasoni G;Caruso A
通讯作者：
Caruso A
影响因子：
8.2
作者：
Cariou, Bertrand;Hadjadj, Samy;Gourdy, Pierre
通讯作者：
Gourdy, Pierre
影响因子：
24.5
作者：
Becchetti, Chiara;Zambelli, Marco Fabrizio;Dufour, Jean-Francois
通讯作者：
Dufour, Jean-Francois