Spectrum of Coronavirus Disease 2019 Outcomes in Kidney Transplant Recipients: A Single-Center Experience.
Spectrum of Coronavirus Disease 2019 Outcomes in Kidney Transplant Recipients: A Single-Center Experience.
复制标题
DOI：
10.1016/j.transproceed.2020.09.005
复制
发表时间：
2020-11
影响因子：
0.9
通讯作者：
Schaenman J
中科院分区：
文献类型：
--
作者：
Lum E;Bunnapradist S;Multani A;Beaird OE;Carlson M;Gaynor P;Kotton C;Abdalla B;Danovitch G;Kendrick E;Nieves-Borrero K;Pham PT;Yabu J;Schaenman J
我们回顾了肾移植受者被诊断为严重急性呼吸综合征冠状病毒2型感染的临床经验，以了解当前冠状病毒病2019年(新冠肺炎)大流行感染对移植受者的影响。鉴于来自受影响严重地区的早期报告显示，肾移植受者的死亡率非常高，在30%到40%之间，我们试图在一个病例负担较高但没有经历因新冠肺炎而出现急性危机的中心评估结果。在这项单中心的回顾性观察研究中，加州大学洛杉矶分校医学中心的所有肾移植受者的医疗记录通过聚合酶链式反应被诊断为新冠肺炎，然后通过图表回顾来确定肾移植的特征和临床过程。应用新冠肺炎聚合酶链式反应对41例肾移植受者进行鉴定。在确诊前，受者移植的平均时间为47个月。少数族裔(西班牙裔占65.9%，黑人占14.6%)、强的松、他克莫司和霉酚酸酯(分别占95.1%、87.8%和87.8%)，移植物功能良好(中位数1.25 mg/dL)。最常见的症状是发热、呼吸困难或咳嗽。大多数患者住院(63.4%)；死亡率为9.8%，仅发生在重症监护病房的患者。最常见的治疗方法是减少或去除抗代谢药物(77.8%)。约26.9%的患者出现AKI。肾移植受者感染新冠肺炎导致的住院率和死亡率高于普通人群。在一个感染人数较多的地区，与早期经历医疗系统激增和紧张的地区的早期报告相比，死亡率较低。少数族裔受到的影响不成比例。需要进一步的研究来确定治疗和管理新冠肺炎感染的肾移植受者免疫抑制的最佳方法。
We reviewed the clinical experience of kidney transplant recipients diagnosed with severe acute respiratory syndrome coronavirus 2 infection in order to understand the impact of the current coronavirus disease 2019 (COVID-19) pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30% and 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. In this single center retrospective observational study, medical records of all kidney transplant recipients at the UCLA Medical Center were reviewed for a diagnosis of COVID-19 by polymerase chain reaction, followed by chart review to determine kidney transplant characteristics and clinical course. A total of 41 kidney transplant recipients were identified with COVID-19 positive polymerase chain reaction. Recipients had been transplanted for a median of 47 months before diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, black 14.6%), on prednisone, tacrolimus, and mycophenolate mofetil (95.1%, 87.8%, and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea, or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the intensive care unit. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. COVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared with earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.
登录
查看更多内容
影响因子：
39
作者：
Wu, Chaomin;Chen, Xiaoyan;Song, Yuanlin
通讯作者：
Song, Yuanlin
影响因子：
14.2
作者：
Lovinsky-Desir, Stephanie;Deshpande, Deepti R.;Kattan, Meyer
通讯作者：
Kattan, Meyer
影响因子：
168.9
作者：
Remuzzi, Andrea;Remuzzi, Giuseppe
通讯作者：
Remuzzi, Giuseppe
影响因子：
8.8
作者：
Nair, Vinay;Jandovitz, Nicholas;Molmenti, Ernesto P.
通讯作者：
Molmenti, Ernesto P.
影响因子：
8.8
作者：
Hart, A.;Smith, J. M.;Israni, A. K.
通讯作者：
Israni, A. K.