Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience
Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience
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DOI：
10.1111/ajt.16176
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发表时间：
2020-08-02
影响因子：
8.8
通讯作者：
Scolari, Francesco
中科院分区：
文献类型：
--
作者：
Bossini, Nicola;Alberici, Federico;Scolari, Francesco
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的肾移植患者的结局仍不清楚。在这里，我们描述了53例2019冠状病毒病（COVID-19）肾移植患者的临床特征、疾病结局和急性呼吸窘迫综合征（ARDS）和死亡的风险因素。53例患者中有8例因病情较轻而作为门诊患者处理，平均减少免疫抑制剂并添加羟氯喹和阿奇霉素;没有患者需要住院，发生ARDS或死亡。由于严重的症状，45/53需要入院：该队列已通过免疫抑制剂停药、甲基强的松龙16 mg/d、羟氯喹和抗病毒药物进行管理。在ARDS的情况下，考虑地塞米松和托珠单抗。约33%的患者发生急性肾损伤，60%发生ARDS，33%死亡。在该组中，血小板减少症与ARDS相关，而基线时淋巴细胞减少症、D-二聚体升高和C-反应蛋白缺乏降低与死亡风险相关。在总体人群中，呼吸困难与ARDS风险和年龄大于60岁相关，呼吸困难与死亡风险相关，仅他克莫司治疗患者的死亡风险有增加的趋势。总之，SARS-CoV-2感染可能对肾移植患者有不同的结局，需要住院的患者发生ARDS和死亡的风险更高。
The outcome of kidney transplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still unclear. Here we describe the clinical characteristics, disease outcome, and risk factors for acute respiratory distress syndrome (ARDS) and death of a cohort of 53 kidney transplant patients with coronavirus disease 2019 (COVID-19). Eight of 53 have been handled as outpatients because of mild disease, on average with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin; no patients required admission, developed ARDS, or died. Because of severe symptoms, 45/53 required admission: this cohort has been managed with immunosuppression withdrawal, methylprednisolone 16 mg/d, hydroxychloroquine, and antiviral drugs. Dexamethasone and tocilizumab were considered in case of ARDS. About 33% of the patients developed acute kidney injury, 60% ARDS, and 33% died. In this group, thrombocytopenia was associated to ARDS whereas lymphopenia at the baseline, higher D-dimer, and lack of C-reactive protein reduction were associated with risk of death. In the overall population, dyspnea was associated with the risk of ARDS and age older than 60 years and dyspnea were associated with the risk of death with only a trend toward an increased risk of death for patients on tacrolimus. In conclusion, SARS-CoV-2 infection may have a variable outcome in renal transplant patients, with higher risk of ARDS and death in the ones requiring admission.