Management of immunosuppression in kidney transplant recipients with COVID‐19 pneumonia: A summary of 41 confirmed cases reported worldwide
Management of immunosuppression in kidney transplant recipients with COVID‐19 pneumonia: A summary of 41 confirmed cases reported worldwide
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DOI：
10.1111/tid.13425
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发表时间：
2020-07
影响因子：
2.6
通讯作者：
Qianchao Hu;Z. Zhong;Y. Xiong;Shaojun Ye;Yanfeng Wang;Q. Ye
中科院分区：
文献类型：
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作者：
Qianchao Hu;Z. Zhong;Y. Xiong;Shaojun Ye;Yanfeng Wang;Q. Ye
对于患有 SARS-CoV-2 肺炎的肾移植受者 (KTR) 的免疫抑制管理尚未达成共识。因此，我们于2019年10月至2020年7月在英文数据库中进行检索，并从全球范围内具有治疗细节的病例中提取数据，共有41名中位年龄为50岁的接受者纳入本研究。其中大多数为男性（75.8%）。最常见的症状是发烧（80.5%）、咳嗽（63.4%）和疲劳（41.5%）。根据肺炎严重程度将患者分为三类：轻症17例（41.5%）、重症15例（36.6%）、危重9例（21.9%）。实验室检查显示，重症患者血清肌酐明显高于轻症或重症患者。 68.3%接受氧气支持；所有患者均接受抗病毒治疗，其中 15 名（36.6%）接受者还接受静脉注射免疫球蛋白和干扰素-α 治疗。 19.5%的患者维持免疫抑制治疗； 36.6%悬浮抗代谢物； 43.9% 仅接受皮质类固醇治疗。 6 例（14.6%）患者死亡（重症：2 例，危重症：4 例）；高肌酐和低淋巴细胞计数是免疫抑制管理的最大挑战。总之，需要密切关注感染COVID-19的KTR的肾功能和淋巴细胞计数，并根据具体情况选择合适的用药方案。
There is no consensus on immunosuppression management for kidney transplant recipients (KTRs) with SARS‐CoV‐2 pneumonia. Therefore, we conducted a search in English database from October 2019 to July 2020 and extracted data from cases with treatment details worldwide, and total of 41 recipients with a median age of 50 years were enrolled in this study. Most of them were males (75.8%). The most common presenting symptoms were fever (80.5%), cough (63.4%), and fatigue (41.5%). Patients were classified into three catalogs according to severity of pneumonia: 17 (41.5%) were mild, 15 (36.6%) severe, and 9 (21.9%) critical disease. Laboratory tests revealed that serum creatinine of critical patients was significantly higher than that of mild or severe patients. 68.3% received oxygen support; all patients received antiviral therapy, and 15 (36.6%) recipients were additionally treated with intravenous immunoglobulin and interferon‐α. 19.5% of patients maintained immunosuppressive therapy; 36.6% suspended antimetabolite; and 43.9% only treated with corticosteroid. Six (14.6%) patients died (severe: 2, critical: 4); high creatinine with low lymphocyte count was the biggest challenge of immunosuppression management. In all, it is necessary to pay close attention to renal function and lymphocyte count in KTRs infected with COVID‐19 and choose appropriate medication programs according to the specific situations.