COVID-19 in solid organ transplant: A multi-center cohort study
COVID-19 in solid organ transplant: A multi-center cohort study
复制标题
实体器官移植中的 COVID-19：一项多中心队列研究
DOI：
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发表时间：
2020
影响因子：
11.8
通讯作者：
Zurabi Lominadze
中科院分区：
文献类型：
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作者：
O. Kates;B. Haydel;S. Florman;M. Rana;Z. Chaudhry;M. Ramesh;K. Safa;C. Kotton;E. Blumberg;B. Besharatian;S. Tanna;M. Ison;M. Malinis;M. Azar;R. Rakita;Jose A Morilla;A. Majeed;A. S. Sait;M. Spaggiari;V. Hemmige;S. Mehta;H. Neumann;A. Badami;J. Goldman;A. Lala;M. Hemmersbach;Margaret E McCort;Valida Bajrovic;C. Ortiz;Rachel J. Friedman;S. Sehgal;E. Lease;C. Fisher;A. Limaye;Akanksha Arya;Amy Jeng;Alexander Kuo;Alfred Luk;Alfredo G. Puing;Ana P Rossi;Andrew J Brueckner;A. Multani;Brian C. Keller;Darby Derringer;D. Florescu;Edward A. Dominguez;Elena Sandoval;Erin P Bilgili;Faris Hashim;Fernanda P Silveira;G. Haidar;Hala G Joharji;Haris F Murad;Imran Y. Gani;J. El;J. Kahwaji;Joyce Popoola;J. Yabu;K. Hughes;K. Saharia;K. Gajurel;Lyndsey J Bowman;Massimiliano Veroux;Megan K Morales;Monica Fung;Nicole Theodoropoulos;O. de la Cruz;Rajan Kapoor;R. L. La Hoz;Sridhar R. Allam;Surabhi B. Vora;Todd P McCarty;Tracy Anderson;Uma Malhotra;Ursula M Kelly;Vidya Bhandaram;William M Bennett;Zurabi Lominadze
摘要背景COVID-19大流行导致移植手术大幅减少，部分原因是担心实体器官移植（SOT）受者的疾病严重程度不成比例。然而，SOT受体的临床特征、结局和死亡率的预测因素尚未得到很好的描述。方法我们对实验室确诊COVID-19的SOT接受者进行了一项多中心队列研究。使用标准化摄入量和28天随访电子病例报告表收集数据。采用多变量logistic回归分析确定住院患者主要终点（28天死亡率）的危险因素。结果来自50个以上移植中心的482例SOT受者包括：318例（66%）肾脏或肾脏/胰腺，73例（15.1%）肝脏，57例（11.8%）心脏和30例（6.2%）肺。中位年龄为58岁（IQR 46-57），移植后中位时间为5年（IQR 2-10），61%为男性，92%有≥1种基础合并症。在住院患者（376例[78%]）中，117例（31%）需要机械通气，77例（20.5%）在诊断后28天死亡。特定基础合并症（年龄>65岁[aOR 3.0，95%CI 1.7-5.5，p<0.001]，充血性心力衰竭[aOR 3.2，95%CI 1.4-7.0，p=0.004]，慢性肺病[aOR 2.5，95%CI 1.2-5.2，p=0.018]，肥胖[aOR 1.9，95%CI 1.0-3.4，p=0.039]）和临床表现（淋巴细胞减少[aOR 1.9，95%CI 1.1-3.5，p=0.033]，胸部影像学异常[aOR 2.9，95%CI 1.1-7.5，p=0.027]）与死亡率独立相关。免疫抑制强度的多项指标与死亡率无关。结论因COVID-19住院的SOT接受者的死亡率为20.5%。年龄和潜在的合并症，而不是免疫抑制强度相关的措施是死亡率的主要驱动因素。
Abstract Background The COVID-19 pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well-described. Methods We performed a multi-center cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients. Results Four hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (IQR 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [aOR 3.0, 95%CI 1.7-5.5, p<0.001], congestive heart failure [aOR 3.2, 95%CI 1.4-7.0, p=0.004], chronic lung disease [aOR 2.5, 95%CI 1.2-5.2, p=0.018], obesity [aOR 1.9, 95% CI 1.0-3.4, p=0.039]) and presenting findings (lymphopenia [aOR 1.9, 95%CI 1.1-3.5, p=0.033], abnormal chest imaging [aOR 2.9, 95%CI 1.1-7.5, p=0.027]) were independently associated with mortality. Multiple measures of immunosuppression intensity were not associated with mortality. Conclusions Mortality among SOT recipients hospitalized for COVID-19 was 20.5%. Age and underlying comorbidities rather than immunosuppression intensity-related measures were major drivers of mortality.
DOI：
10.1016/s1473-3099(10)70133-x
发表时间：
2010-08
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Kumar D;Michaels MG;Morris MI;Green M;Avery RK;Liu C;Danziger-Isakov L;Stosor V;Estabrook M;Gantt S;Marr KA;Martin S;Silveira FP;Razonable RR;Allen UD;Levi ME;Lyon GM;Bell LE;Huprikar S;Patel G;Gregg KS;Pursell K;Helmersen D;Julian KG;Shiley K;Bono B;Dharnidharka VR;Alavi G;Kalpoe JS;Shoham S;Reid GE;Humar A;American Society of Transplantation H1N1 Collaborative Study Group
通讯作者：
American Society of Transplantation H1N1 Collaborative Study Group
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,