Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A case-control study
Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A case-control study
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DOI：
10.1111/ajt.16188
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发表时间：
2020-07-28
影响因子：
8.8
通讯作者：
Alangaden, George J.
中科院分区：
文献类型：
--
作者：
Chaudhry, Zohra S.;Williams, Jonathan D.;Alangaden, George J.
由于免疫抑制和合并症，与非移植患者相比，患有2019冠状病毒病（COVID-19）的实体器官移植受者（SOTr）的结局预计会更差。将47例SOTr（38个肾脏和9个非肾脏器官）的临床特征与100例连续住院非移植对照进行比较。47名SOTr门诊患者中有12名随后从结局分析中排除，以避免潜在的选择偏倚。与对照组相比，35例住院SOTr患者中慢性肾脏疾病（89% vs 57%P =.0007）、糖尿病（66% vs 33%P = .0007）和高血压（94% vs 72%P = .006）更为常见。腹泻（54%比17%，P <0.0001）在SOTr组更常见。SOTr组和对照组的主要复合结局（升级至重症监护室、机械通气或院内全因死亡率）相似（40% vs 48%，比值比[OR] 0.72置信区间[CI] [0.33-1.58]P = 0.42），尽管SOTr组的合并症更多。需要肾脏替代治疗的急性肾损伤在SOTr组中发生率为20%，而对照组为4%（OR 6 CI [1.64-22]P = .007）。多因素分析表明，年龄和临床严重程度的增加与死亡率相关。移植状态本身与死亡率无关。
Solid organ transplant recipients (SOTr) with coronavirus disease 2019 (COVID-19) are expected to have poorer outcomes compared to nontransplant patients because of immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 nonkidney organs) were compared to 100 consecutive hospitalized nontransplant controls. Twelve of 47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs 57%P = .0007), diabetes (66% vs 33%P = .0007), and hypertension (94% vs 72%P = .006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs 17%,P < .0001) was more frequent in SOTr. Primary composite outcome (escalation to intensive care unit, mechanical ventilation, or in-hospital all-cause mortality) was comparable between SOTr and controls (40% vs 48%, odds ratio [OR] 0.72 confidence interval [CI] [0.33-1.58]P = .42), despite more comorbidities in SOTr. Acute kidney injury requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64-22]P = .007). Multivariate analysis demonstrated that increasing age and clinical severity were associated with mortality. Transplant status itself was not associated with mortality.