Infections Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan, China
Infections Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan, China
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DOI：
10.1016/j.eururo.2020.03.039
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发表时间：
2020-06-01
期刊：
影响因子：
23.4
通讯作者：
Chen, Zhishui
中科院分区：
文献类型：
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作者：
Zhu, Lan;Gong, Nianqiao;Chen, Zhishui
之前关于2019冠状病毒病（COVID-19）的研究主要集中在免疫功能正常的人群中，但缺乏免疫功能低下人群的数据。目的探讨肾移植受者新冠肺炎的临床特点及预后。设计、环境和参与者本回顾性研究共纳入了10例实验室确诊的COVID-19肺炎肾移植受者。此外，将10名确诊为COVID-19肺炎的家庭成员纳入对照组。干预：减少免疫抑制剂和低剂量甲基强的松龙治疗。结果测量与统计分析临床结果（肺炎严重程度、康复率、病毒脱落时间、疾病持续时间）与对照组进行统计学分析比较。结果与局限性肾移植受者的COVID-19肺炎的临床症状、实验室和影像学特征与普通人群的重症COVID-19肺炎相似。移植受者的COVID-19肺炎严重程度高于对照组（5例严重/ 3例危重病例vs 1例严重病例）。5例发生短暂性肾移植损害。10例移植患者中有9例治疗后恢复顺利，病毒脱落时间较长（对照组为28.4±9.3 vs 12.2±4.6 d），病程较长（对照组为35.3±8.3 vs 18.8±10.5 d）。1例患者发生急性肾移植衰竭并死于进行性呼吸衰竭。结论肾移植受者COVID-19肺炎的严重程度高于普通人群，但大多数患者经较长临床病程和病毒脱落后痊愈。这一小部分病例的发现可能对免疫抑制人群中COVID-19肺炎的治疗具有重要意义。2019冠状病毒病感染的免疫抑制移植受者肺炎较为严重，但经适当治疗后多数患者预后良好。
BackgroundPrevious studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations.ObjectiveTo evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients.Design, setting, and participantsA total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group.InterventionImmunosuppressant reduction and low-dose methylprednisolone therapy.Outcome measurements and statistical analysisThe clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis.Results and limitationsThe clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure.ConclusionsKidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations.Patient summaryImmunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.