背景:在过去的3年中,COVID-19大流行极大地影响了人类生活的各个方面。在这项研究中,我们专注于从COVID-19诊断开始的肾移植患者,免疫抑制药物修饰,住院治疗,和COVID-19并发症以及COVID-19感染如何影响住院期间和出院后的肾脏和患者的生活质量。
方法:对2020年1月1日至2022年12月30日COVID-19PCR阳性并有肾移植史的所有肾移植成年患者的前瞻性数据库进行回顾性分析。
结果:188例患者符合纳入标准,被纳入研究。基于COVID-19感染期间的免疫抑制方案修改,患者分为两组;143例(76%)患者,免疫抑制药物减少了,在45(24%)的患者中,在COVID-19感染期间,免疫抑制方案继续进行。在我们减少IM方案的组中,从移植到诊断COVID-19的平均时间为67个月,该组为77个月,未改变IM方案。在我们减少IM方案的组中,平均接受者年龄为50.7±12.9岁,和51.8±16.4年在未改变IM方案组(P=0.64)。在我们减少IM方案的组中,至少2剂CDC推荐的Moderna或Pfizer疫苗对COVID-19的疫苗接种率为80.2%,IM方案无变化组的84.8%(P=0.55)。在我们减少IM方案的组中,由于COVID-19相关症状导致的住院率为22.4%,在IM方案无变化的组中为35.5%(P=0.12)。然而,我们减少IM方案组的ICU入院率较高,但差异不显著(26.5%Vs.6.25%,P=0.12)。在IM减少的组中观察到6次活检证实的排斥反应。分别是3次急性抗体介导的排斥反应(ABMR)和3次急性T细胞介导的排斥反应(TCMR),该组3次发作,IM方案无任何变化,其中ABMR2次发作和TCMR1次发作(P=0.51)。随访12个月后,组间比较eGFR和血肌酐无明显差异。124名患者回答了COVID-19后问卷,并被纳入数据分析。反应率为66%。疲劳和劳累是报告最多的症状,患病率为43.9%。
结论:我们发现,最小化免疫抑制方案不会对肾脏功能产生长期影响,这可能是一个有用的策略,可以在住院期间最小化COVID-19感染对患者病情的影响。所有的治疗,疫苗接种,和预防措施,与COVID-19之前的健康状况相比,仍有一些患者没有完全康复。疲劳是所有报告症状中的主要报告症状。
BACKGROUND: COVID-19 pandemic had tremendously affected all the aspects of human life during the past 3 years. In this study, we focused on kidney transplant patients\' course from the COVID-19 diagnosis, immunosuppressive medication modification, hospitalization, and COVID-19 complications and how the COVID-19 infection affected the kidney and patients\' quality of life during the hospitalization and after the discharge.
METHODS: A retrospective analysis of a prospectively collected database of all kidney transplants adult patients who had a positive COVID-19 PCR from 1 January 2020 to 30 December 2022, and had a history of kidney transplant at the SUNY Upstate Medical Hospital was done to identify the cases.
RESULTS: 188 patients met the inclusion criteria and were included in the study. Based on the immunosuppressive regimen modification during COVID-19 infection, patients divided into two groups; in 143 (76%) patients, the immunosuppressive medication was reduced, and in 45 (24%) of patients, the immunosuppressive regimen continued as before during the COVID-19 infection. The mean time from the transplant to the diagnosis of COVID-19 was 67 months in the group we reduced the IM regimen, and 77 months in the group without changes in IM regimen. The mean recipients\' age was 50.7 ± 12.9 years in the group we reduced the IM regimen, and 51.8 ± 16.4 years in the group without changes in IM regimen (P = 0.64). The vaccination rate against COVID-19 with at least 2 doses of either the CDC recommended Moderna or Pfizer vaccines was 80.2% in the group we reduced the IM regimen, and 84.8% in the group without changes in IM regimen (P = 0.55). The hospitalization rate due to COVID-19 related symptoms was 22.4% % in the group we reduced the IM regimen, and 35.5% in the group without changes in IM regimen (P = 0.12). However, the ICU admission rate was higher in the group we reduced the IM regimen, but the difference was not significant (26.5% Vs.6.25%, P = 0.12). 6 episodes of biopsy-proven rejection in the group with IM reduction was observed, which were 3 episodes of acute antibody-mediated rejections (ABMR) and 3 episodes of acute T-Cell-mediated rejections (TCMR), and 3 episodes in the group without any change in IM regimen, which were 2 episodes of ABMR and 1 episode of TCMR (P = 0.51). No significant difference was mentioned in the eGFR and serum creatinine after the comparison between the groups after 12 months of follow up. 124 patients responded to the post-COVID-19 questionnaires and were included in the data analysis. The response rate was 66%. Fatigue and exertion were the most reported symptom with a 43.9% prevalence.
CONCLUSIONS: We found that immunosuppressive regimen minimization did not impact the kidney function in the long-term and it might be a helpful strategy to minimize the effect of COVID-19 infection on patients\' condition during the hospital stay. With all the treatments, vaccinations, and precautions, still some patients did not achieve the complete recovery compared to their pre-COVID-19 health status. Fatigue was the main reported symptom amongst all the reported symptoms.