An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants
An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants
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DOI：
10.1016/j.kint.2020.08.005
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发表时间：
2020-12-01
影响因子：
19.6
通讯作者：
Hazzan, Marc
中科院分区：
文献类型：
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作者：
Caillard, Sophie;Anglicheau, Dany;Hazzan, Marc
尽管2019冠状病毒病（COVID-19）大流行仍在持续，但有关其在肾移植受者中的临床表现和预后的信息仍然很少。这项基于登记的观察性研究的目的是探索法国全国新冠肺炎实体器官移植受者登记处中纳入的肾移植受者的特征和临床结局。COVID-19是在SARS-CoV-2 PCR检测阳性或影像学上有典型肺部病变的有症状患者中诊断出来的。记录临床和实验室特征、免疫抑制管理、新冠肺炎治疗和临床结局（住院、入住重症监护室、机械通气或死亡）。确定了严重疾病或死亡的风险因素。279名患者中，243人入院治疗，36人在家管理。住院患者的中位年龄为61.6岁;大多数患有合并症（高血压，90.1%;超重，63.8%;糖尿病，41.3%;心血管疾病，36.2%）。发热、咳嗽、呼吸困难和腹泻是入院时最常见的症状。实验室检查结果显示轻度炎症经常伴有淋巴细胞减少症。免疫抑制药物通常被停用（钙调磷酸酶抑制剂：28.7%;抗代谢药：70.8%）。治疗主要基于羟氯喹（24.7%）、抗病毒药物（7.8%）和托珠单抗（5.3%）。106名患者（46%）发生了严重的Covid-19。43例住院患者死亡（30天死亡率22.8%）。多变量分析表明，超重、发热和呼吸困难是严重疾病的独立危险因素，而年龄超过60岁、心血管疾病和呼吸困难与死亡率独立相关。因此，肾移植受者的新冠肺炎预示着高死亡率。对这一人群进行适当的免疫抑制管理和定制治疗仍然具有挑战性。
Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day mortality 22.8%). Multivariable analysis identified overweight, fever, and dyspnea as independent risk factors for severe disease, whereas age over 60 years, cardiovascular disease, and dyspnea were independently associated with mortality. Thus, Covid-19 in recipients of kidney transplants portends a high mortality rate. Proper management of immunosuppression and tailored treatment of this population remain challenging.