COVID-19 in an international European liver transplant recipient cohort
COVID-19 in an international European liver transplant recipient cohort
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DOI：
10.1136/gutjnl-2020-321923
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发表时间：
2020-10-01
期刊：
影响因子：
24.5
通讯作者：
Dufour, Jean-Francois
中科院分区：
文献类型：
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作者：
Becchetti, Chiara;Zambelli, Marco Fabrizio;Dufour, Jean-Francois
目的目前对肝移植受者严重急性呼吸综合征冠状病毒2型（SARS CoV 2）感染的认识不足，尤其是严重程度。本研究的目的是描述欧洲一组SARS-CoV-2感染肝移植受者的人口统计学、基线临床特征和早期结局。设计我们在欧洲进行了一项国际前瞻性研究，研究对象是在COVID-19大流行首次爆发期间经微生物学检测证实感染SARS-CoV-2的肝移植受者。收集基线特征、临床表现、免疫抑制治疗管理和结局。结果共纳入57例患者（70%为男性，诊断时的中位（IQR）年龄为65（57-70）岁）。分别有21例（37%）、32例（56%）和21例（37%）患者患有一种心血管疾病、动脉高血压和糖尿病。最常见的症状是发热（79%）、咳嗽（55%）、呼吸困难（46%）、疲劳或肌痛（56%）和胃肠道症状（33%）。22例受者（37%）免疫抑制减少，4例（7%）停止。在这方面，未观察到对结局的影响。41名（72%）受试者住院，11名（19%）出现急性呼吸窘迫综合征。总体而言，我们估计病死率为12%（95% CI 5%至24%），在住院患者中增加至17%（95% CI 7%至32%）。死亡的7名患者中有5人有癌症史。结论在这项针对肝移植受者的欧洲多中心前瞻性研究中，COVID-19与总体和院内死亡率相关，分别为12%（95%CI 5%至24%）和17%（95%CI 7%至32%）。癌症史在预后较差的患者中更常见。
Objective Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection. Design We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. Results 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57-70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer. Conclusion In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome.