Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics.
Outcomes of SOT Recipients With COVID-19 in Different Eras of COVID-19 Therapeutics.
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DOI：
10.1097/txd.0000000000001268
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发表时间：
2022-01
影响因子：
2.3
通讯作者：
Avery RK
中科院分区：
文献类型：
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作者：
Sait AS;Chiang TP;Marr KA;Massie AB;Cochran W;Shah P;Brennan DC;Thomas AG;Mehta Steinke S;Permpalung N;Shoham S;Merlo C;Jain T;Boyarsky B;Charnaya O;Gurakar A;Sharma K;Durand CM;Werbel WA;Huang CY;Ostrander D;Desai N;Kim MY;Alasfar S;Bloch EM;Tobian AAR;Garonzik-Wang J;Segev DL;Avery RK
补充数字内容可在正文中找到。很少有报告集中在实体器官移植受者中新的冠状病毒病2019(新冠肺炎)疗法(瑞希韦、地塞米松和恢复期血浆)；人们对可能对同种异体移植功能的不利影响或继发感染提出了担忧。我们研究了2个治疗时期(ERA 1：2020年3月至5月，21例；ERA 2：2020年6月至11月，56例)的77例新冠肺炎实体器官移植住院患者和52例实体器官移植门诊患者。ER1组患者未接受瑞希韦或地塞米松治疗，其中4例(19.4%)患者接受恢复期血浆治疗，而ER2组患者常用瑞美昔韦(24/56，42.9%)、地塞米松(24/56，42.9%)和恢复期血浆(40/56，71.4%)。两个时代的死亡率都很低，77人中有4人(5.6%)发生排斥反应，77名住院患者中只有2人(2.8%)发生排斥反应；无论是否使用地塞米松，低氧血症患者的感染情况相似。先前存在的移植物功能障碍与更大的住院需求、更高的严重程度评分和更低的存活率相关。37.3%的住院患者存在急性肾损伤；接受雷米夫韦和恢复期血浆治疗的患者肾功能改善更快。新冠肺炎术后的肾功能和肝功能在不同的时代之间是相似的，直到90d。较新的新冠肺炎疗法似乎对同种异体移植的功能没有有害影响，感染并发症也是相似的。
Supplemental Digital Content is available in the text. Few reports have focused on newer coronavirus disease 2019 (COVID-19) therapies (remdesivir, dexamethasone, and convalescent plasma) in solid organ transplant recipients; concerns had been raised regarding possible adverse impact on allograft function or secondary infections. We studied 77 solid organ transplant inpatients with COVID-19 during 2 therapeutic eras (Era 1: March–May 2020, 21 patients; and Era 2: June–November 2020, 56 patients) and 52 solid organ transplant outpatients. In Era 1, no patients received remdesivir or dexamethasone, and 4 of 21 (19.4%) received convalescent plasma, whereas in Era 2, remdesivir (24/56, 42.9%), dexamethasone (24/56, 42.9%), and convalescent plasma (40/56, 71.4%) were commonly used. Mortality was low across both eras, 4 of 77 (5.6%), and rejection occurred in only 2 of 77 (2.8%) inpatients; infections were similar in hypoxemic patients with or without dexamethasone. Preexisting graft dysfunction was associated with greater need for hospitalization, higher severity score, and lower survival. Acute kidney injury was present in 37.3% of inpatients; renal function improved more rapidly in patients who received remdesivir and convalescent plasma. Post–COVID-19 renal and liver function were comparable between eras, out to 90 d. Newer COVID-19 therapies did not appear to have a deleterious effect on allograft function, and infectious complications were comparable.