COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium
COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium
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DOI：
10.1111/ajt.16185
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发表时间：
2020-08-04
影响因子：
8.8
通讯作者：
Riella, Leonardo, V
中科院分区：
文献类型：
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作者：
Cravedi, Paolo;Mothi, Suraj S.;Riella, Leonardo, V
肾移植受者可能因慢性免疫抑制和合并症而患上严重冠状病毒2019年病(新冠肺炎)的高风险。我们在美国、意大利和西班牙的12个移植中心确定了新冠肺炎检测呈阳性的住院成人肾移植受者。回顾了临床表现、实验室价值、免疫抑制和治疗策略，并通过多变量分析确定了不良临床结果的预测因素。在9,845名跨中心的肾移植受者中，144人在9周的研究期间因新冠肺炎而住院。在144名患者中，66%是男性，平均年龄为60岁(+/-12)，40%是西班牙裔，25%是非裔美国人。常见的并存疾病包括高血压(95%)、糖尿病(52%)、肥胖(49%)、心肺疾病(28%)和肺病(19%)。治疗措施包括停用抗代谢药物(68%)、钙调神经磷酸酶抑制剂(23%)、羟氯喹(71%)、抗生素(74%)、妥昔珠单抗(13%)和抗病毒药物(14%)。中位随访52天(IQR：16~66天)，急性肾损伤发生率为52%，呼吸衰竭需插管发生率为29%，死亡率为32%。死亡的46名患者年龄较大，淋巴细胞计数较低，估计肾小球滤过率水平，而血清乳酸脱氢酶、降钙素原和白细胞介素6水平较高。总而言之，接受新冠肺炎治疗的住院肾移植患者的急性肾损伤和死亡率较高。
Kidney transplant recipients may be at a high risk of developing critical coronavirus disease 2019 (COVID-19) illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the United States, Italy, and Spain who tested positive for COVID-19. Clinical presentation, laboratory values, immunosuppression, and treatment strategies were reviewed, and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9845 kidney transplant recipients across centers, 144 were hospitalized due to COVID-19 during the 9-week study period. Of the 144 patients, 66% were male with a mean age of 60 (+/- 12) years, and 40% were Hispanic and 25% were African American. Prevalent comorbidities included hypertension (95%), diabetes (52%), obesity (49%), and heart (28%) and lung (19%) disease. Therapeutic management included antimetabolite withdrawal (68%), calcineurin inhibitor withdrawal (23%), hydroxychloroquine (71%), antibiotics (74%), tocilizumab (13%), and antivirals (14%). During a median follow-up period of 52 days (IQR: 16-66 days), acute kidney injury occurred in 52% cases, with respiratory failure requiring intubation in 29%, and the mortality rate was 32%. The 46 patients who died were older, had lower lymphocyte counts and estimated glomerular filtration rate levels, and had higher serum lactate dehydrogenase, procalcitonin, and interleukin-6 levels. In sum, hospitalized kidney transplant recipients with COVID-19 have higher rates of acute kidney injury and mortality.