SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region
SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region
复制标题
DOI：
10.1111/tid.13377
复制
发表时间：
2020-07-28
影响因子：
2.6
通讯作者：
Ranghino, Andrea
中科院分区：
文献类型：
--
作者：
Maritati, Federica;Cerutti, Elisabetta;Ranghino, Andrea
背景与冠状病毒19（CoV-2）相关的感染是一种大流行病，影响全球187个国家的400多万人。截至2020年5月10日，它在全球造成超过28万人死亡。初步数据报告了肾移植患者（KTR）中严重急性呼吸综合征相关CoV-2（SARS-CoV-2）导致的CoV-2感染和死亡率较高。然而，结果和最佳治疗SARS-CoV-2受影响的KTR仍不清楚。方法回顾性分析3月17日至今在意大利马尔凯地区安科纳收治的5例SARS冠状病毒2型KTR患者的临床资料、治疗方法和转归。由于SARS-CoV-2的严重程度，在入院时停止使用钙调磷酸酶抑制剂、抗代谢药和mTOR抑制剂进行免疫抑制。所有KTR均接受低剂量类固醇治疗。4/5例KTR接受羟氯喹治疗。所有KTR均接受了最多1剂托珠单抗。结果总体而言，马尔凯地区KTR中SARS-CoV-2的发病率为0.85%。3/5人入住ICU并插管。1例发生阿基，需要使用Cytosorb进行CRRT。目前，2名患者死亡，2名患者出院，1名患者仍在ICU住院。结论所有病例的关键性评价表明，托珠单抗（一种白细胞介素-6受体拮抗剂）的给药时机与氧饱和度下降同时给药可能具有更好的疗效。因此，在SARS-CoV-2感染的KTR中，应建立密切的生化和临床监测，以使医生能够在正确的时刻打击病毒，例如血氧饱和度突然降低和/或实验室值（如D-二聚体）显著增加。
Background Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear. Methods In this report, we describe the clinical data, the treatments, and the outcomes of 5 KTRs with SARS-CoV-2 admitted to our hospital in Ancona, Marche region, Italy, from March 17 to present. Due to the severity of SARS-CoV-2, immunosuppression with calcineurin inhibitors, antimetabolites, and mTOR-inhibitors were stopped at the admission. All KTRs were treated with low-dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose. Results Overall, the incidence of SARS-CoV-2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present, two patients died, two patients were discharged, and one is still inpatient in ICU. Conclusions The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin-6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS-CoV-2-affected KTRs, a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase in the laboratory values such as D-dimer.