SARS-CoV-2 infection in liver transplant recipients: collaboration in the time of COVID-19.
SARS-CoV-2 infection in liver transplant recipients: collaboration in the time of COVID-19.
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DOI：
10.1016/s2468-1253(20)30293-4
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Taner T
中科院分区：
文献类型：
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作者：
Heimbach JK;Taner T
评论www.我的天使com/gastrohep 2020年11月5日959名患有COVID-19但尚未接受肝脏移植的患者（n= 627），从英国牛津四家医院的电子病历中收集数据。重要的是，该报告提供了对肝移植患者风险的估计-他们必须平衡持续医疗护理的需要和保持隔离以减少SARS-CoV-2暴露的需要-并且还展示了国际合作在解决关键卫生保健挑战方面的力量。该研究发现肝移植组（124例[82%]患者）和非肝移植组（474例[76%]患者; p= 0.106）的住院患者比例无差异。尽管肝移植受者对有创通气支持的需求增加（30例[20%] vs对照组32例[5%]，p<0.0001），但肝移植受者的死亡率（28例[19%]）显著低于未接受肝移植的患者（167例[27%]; p= 0.046）。在倾向评分匹配分析中（调整年龄、性别、肌酐浓度、肥胖、高血压、糖尿病和种族），肝移植并没有显著增加SARS-CoV-2感染患者的死亡风险（绝对风险差异1.4%[95%CI-7.7至10.4]）。COVID-19肺病是两组死亡的主要原因，重要的是，接受移植的病人中没有与肝脏有关的死亡。多变量分析显示，与肝移植受者死亡相关的因素包括年龄和肌酐浓度，以及非肝脏恶性肿瘤的存在，而移植时间和免疫抑制类型与死亡风险无关。在对照人群中，多变量分析显示年龄、男性和糖尿病是死亡的主要危险因素。另一个值得注意的发现是肝移植队列中胃肠道症状的发生率更高，诊断时有30%的患者有腹痛、呕吐或腹泻，而对照组只有12%的患者有腹部症状（p<0.0001）。目前的分析有一些重要的警告，例如两个队列之间的显著差异。尽管年龄是一个关键的风险因素，在对照队列中（中位数73岁[IQR 55-84]）高于肝移植队列（中位数60岁[47-66]），但肝移植组
Comment www. thelancet. com/gastrohep Vol 5 November 2020 959 with COVID-19 who have not received a liver transplant (n= 627), having collected data from the electronic patient records of group of four hospitals in Oxford, UK. Importantly, the report provides an estimation of the risks for liver transplant recipients—who must balance the need for ongoing medical care with the need to remain isolated to reduce exposure to SARS-CoV-2—and also demonstrates the power of international collaboration in solving critical health-care challenges. The study found no difference in the proportion of patients hospitalised between the liver transplant (124 [82%] patients) and the non-liver transplant cohort (474 [76%] patients; p= 0· 106). Despite an increased need for invasive ventilation support among recipients of liver transplants (30 [20%] vs 32 [5%] in the comparison cohort, p< 0· 0001), mortality was significantly lower in liver transplant recipients (28 [19%]) than in patients who had not received a liver transplant (167 [27%]; p= 0· 046). In a propensity scorematched analysis (adjusting for age, sex, creatinine concentration, obesity, hypertension, diabetes, and ethnicity), liver transplantation did not significantly increase the risk of death in patients with SARS-CoV-2 infection (absolute risk difference 1· 4%[95% CI–7· 7 to 10· 4]).COVID-19 lung disease was the main cause of death in both groups and, importantly, there were no liverrelated deaths among the transplant recipients. Multivariable analysis showed that factors associated with death among liver transplant recipients included age and creatinine concentration, as well as the presence of non-liver malignancy, whereas time from transplantation and type of immunosuppression were not related to risk of death. In the control population, multivariable analysis showed age, male sex, and diabetes to be the major risk factors for death. An additional notable finding was the higher rates of gastrointestinal symptoms in the liver transplant cohort, with 30% having abdominal pain, vomiting, or diarrhoea at diagnosis compared with just 12% of the control group having abdominal symptoms (p< 0· 0001). There are some important caveats to the current analysis, such as the significant differences between the two cohorts. Although age, a key risk factor, was higher in the comparison cohort (median 73 years [IQR 55–84]) than the liver transplant cohort (median 60 years [47–66]), the liver transplant group had