Abstract
Due to the COVID-19 pandemic caused by infection with the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant medicine also had to face a new, hitherto unknown challenge. To be prepared for any possibility, we consider it important to summarize the current knowledge regarding COVID-19 of liver and kidney transplant patients. Very early reports from Spanish and French registry recorded fatality rates of 18.6% and 13%, respectively, in renal patients which suggests a moderately worse outcome compared to the general population. In patients with positive PCR test but not showing clinical signs, the reduction of immunosuppression is not advised. In the case of gastrointestinal or respiratory signs with fever, the discontinuation of mycophenolate or mTOR inhibitors is recommended with decrease of the trough levels of calcineurin inhibitors to the lowest effective limit. Stop (kidney transplanted patients) or decrease (liver transplanted patients) immunosuppression and maintain corticosteroids when pulmonal injury develops and consider anti-IL1 and anti-IL6 monoclonal antibody use when hyperinflammatory syndrome is evolving. No proven effective treatment for SARS-CoV-2 exists currently. The use of lopinavir/ritonavir should be avoided because of the severe drug interaction with calcineurin inhibitors. The efficacy and tolerability of hidroxychloroquin remains to be also questionable; enroll patients into clinical trial with remdesivir or favipiravir if available. COVID-19 is characterized by virus-induced endothelial dysfunction, procoagulant state and renin-angiotensin-aldosteron system imbalance. Early thromboprofilaxis combination with low-molecular-weight heparin and low-dose aspirin is strongly recommended with the maintenance of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II-receptor blocker (ARB) therapy when they were prescribed earlier. Orv Hetil. 2020; 161(32): 1310-1321.
Highlights
Az új koronavírus okozta COVID–19-járvány kihívást jelent a szervátültetett betegek ellátását illetően is, ezért lényegesnek tartjuk az ezzel kapcsolatos friss ismeretek megosztását a hazai ellátásban dolgozók számára
Due to the COVID-19 pandemic caused by infection with the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant medicine had to face a new, hitherto unknown challenge
Very early reports from Spanish and French registry recorded fatality rates of 18.6% and 13%, respectively, in renal patients which suggests a moderately worse outcome compared to the general population
Summary
Az új koronavírus (SARS-CoV-2) okozta fertőzésben szenvedő vese- és májátültetett betegek ellátásának speciális szempontjai. Család, A alcsalád, 4-es gén; ECMO = extracorporalis membránoxigenizáció; EDTA = (ethylenediaminetetraacetic acid) etilén-diamin-tetraecetsav; eGFR = (estimated glomerulus filtration rate) becsült glomerulusfiltrációs ráta; FDA = (U.S Food and Drug Administra tion) az Amerikai Egyesült Államok Élelmiszer-biztonsági és Gyógyszerészeti Hivatala; GGT = gamma-glutamil-transz feráz; GM-CSF = (granulocyte-macrophage colony-stimulating factor) granulocyta-macrophag kolónia stimuláló faktor; GOT = glutamát-oxálacetát-transzamináz; GPT = glutamát- piruvát-transzamináz; HBV = hepatitis B-vírus; HCV = hepatitis C-vírus; HIS = hyperinflammatiós szindróma; HLH = haemophagocytás lymphohistiocytosis; IL1 = interleukin-1; IL6 = interleukin-6; ITO = intenzív terápiás osztály; KDIGO = (Kidney Disease – Improving Global Outcomes) Vesebetegség – A globális eredmények javítása; LDH = laktát-dehidrogenáz; LMWH = (low-molecular-weight heparine) kis molekulasúlyú heparin; MAS = (macrophage activation syndrome) macrophag aktivációs szindróma; mTOR = (mammalian target of rapamycin) a rapamicin célpontja emlősökben; NSAID = (non-steroidal anti-inflammatory drug) nemszteroid gyulladáscsökkentő gyógyszer; OGYÉI = Országos Gyógyszerészeti és Élelmezésegészségügyi Intézet; PCR = (polymerase chain reaction) polimeráz-láncreakció; PCT = (procalcitonin) prokalcitonin; RAAS = (renin-angiotensin-aldosterone system) renin-angiotenzinaldoszteron rendszer; RNS = ribonukleinsav; SARS-CoV-2 = (severe acute respiratory syndrome coronavirus 2) súlyos akut légúti tünetegyüttest okozó koronavírus-2; TLR = (Toll-like receptors) toll-szerű receptor; USA = (United States of America) Amerikai Egyesült Államok.
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