transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-4-339-355transplantologiya-611Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONОсобенности течения и исходы новой коронавирусной инфекции у реципиентов ренального трансплантатаClinical characteristics and outcomes of COVID-19 in kidney transplant recipientsКантарияР. О.KantariyaR. O.

Русудана Отаровна Кантария, канд. мед. наук, доцент кафедры трансплантологии, нефрологии и искусственных органов, врач-нефролог отделения трансплантации почки

129110, Москва, ул. Щепкина, д. 61/2

Rusudana O. Kantariya, Cand. Sci. (Med.), Associate Professor of the Department of Transplantology, Nephrology and Artificial Organs, Nephrologist of the Department of Kidney Transplantation

61/2 Schepkin St., Moscow 129110

https://orcid.org/0000-0002-0002-9183МойсюкЯ. Г.MoysyukYa. G.

Ян Геннадиевич Мойсюк, проф., д-р мед. наук, руководитель отдела трансплантологии

129110, Москва, ул. Щепкина, д. 61/2

Yan G. Moysyuk, Prof., Dr. Sci. (Med.), Head of the Department of Transplantology

61/2 Schepkin St., Moscow 129110

moysyuktrans@list.ruhttps://orcid.org/0000-0002-7686-9816ПрокопенкоЕ. И.ProkopenkoE. I.

Елена Ивановна Прокопенко, д-р мед. наук, профессор кафедры трансплантологии, нефрологии и искусственных органов

129110, Москва, ул. Щепкина, д. 61/2

Elena I. Prokopenko, Dr. Sci. (Med.), Professor of the Department of Transplantology, Nephrology and Artificial Organs

61/2 Schepkin St., Moscow 129110

https://orcid.org/0000-0002-6276-6648КарапитьянА. Р.KarapityanA. R.

Артем Ромэнович Карапитьян, младший научный сотрудник, врач-хирург отделения трансплантации почки

129110, Москва, ул. Щепкина, д. 61/2

Artеm R. Karapityan, Junior Researcher, Surgeon of the Department of Kidney Transplantation

61/2 Schepkin St., Moscow 129110

ark_136@mail.ruАммосовА. А.AmmosovA. A.

Александр Александрович Аммосов, канд. мед. наук, врач-хирург отделения трансплантации печени

129110, Москва, ул. Щепкина, д. 61/2

Alexandr A. Ammosov, Cand. Sci. (Med.), Surgeon of the Department of Liver Transplantation

61/2 Schepkin St., Moscow 129110

МакевнинаА. В.MakevninaA. V.

Александра Викторовна Макевнина, заведующий терапевтическим отделением с дневным стационаром консультативно-диагностического центра

129110, Москва, ул. Щепкина, д. 61/2

Aleksandra V. Makevnina, Chief of the Department of Therapy with a daytime patient facility at Consultative and Diagnostic Center

61/2 Schepkin St., Moscow 129110

https://orcid.org/0000-0003-2391-502XГайдароваА. А.GaydarovaA. A.

Анна Алексеевна Гайдарова, младший научный сотрудник отдела трансплантологии

129110, Москва, ул. Щепкина, д. 61/2

Anna A. Gaydarova, Junior Researcher of the Department of Transplantology

61/2 Schepkin St., Moscow 129110

ГБУЗ МО МОНИКИ им. М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical Institute n.a. M.F. VladimirskiyRussian Federation202115122021134339355Copyright © Кантария Р.О., Мойсюк Я.Г., Прокопенко Е.И., Карапитьян А.Р., Аммосов А.А., Макевнина А.В., Гайдарова А.А., 20212021Кантария Р.О., Мойсюк Я.Г., Прокопенко Е.И., Карапитьян А.Р., Аммосов А.А., Макевнина А.В., Гайдарова А.А.Kantariya R.O., Moysyuk Y.G., Prokopenko E.I., Karapityan A.R., Ammosov A.A., Makevnina A.V., Gaydarova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/611Введение

Введение. Пандемия, вызванная коронавирусом SARS-CoV-2, характеризуется значительной заболеваемостью и смертностью. Реципиенты трансплантата почки находятся в группе высокого риска более тяжелого течения коронавирусной инфекции ввиду постоянной иммуносупрессии, высокого индекса коморбидности, нередко пожилого возраста.

Цель исследования

Цель исследования. Изучить особенности клинического течения, применяемой терапии и исходов новой коронавирусной инфекции у пациентов после трансплантации почки.

Материал и методы

Материал и методы. В ретроспективное исследование включены 69 взрослых реципиентов трансплантата почки, постоянно наблюдавшихся в нашем центре и заболевших COVID-19 в период с апреля 2020 г. по февраль 2021 г. Проведен сравнительный анализ клинической картины, результатов лабораторных и инструментальных исследований, особенностей терапии, а также исходов заболевания новой коронавирусной инфекцией.

Результаты

Результаты. Наиболее частыми клиническими симптомами были гипертермия (85,5%, n=59), общая слабость (65,2%, n=45) и кашель (52,2%, n=36), другие симптомы встречались существенно реже. В 89,5% случаев (n=60) методом полимеразной цепной реакции обнаружена рибонуклеиновая кислота вируса, в 10,5% случаев (n=7) результаты полимеразной цепной реакции были отрицательными. По данным компьютерной томографии (КТ) при поступлении в стационар объем поражения легочной ткани, соответствующий КТ1, выявлен у 28 пациентов (46,7%), КТ2 – у 24 (40%), а в 8 случаях (13%) поражение соответствовало КТ3. В дальнейшем доля пациентов с поражением легочной ткани более 50% увеличилась до 26,7% (n=16), в 1 случае поражение легких соответствовало КТ4.

Характерными признаками для всех пациентов были наличие анемии и лимфопении различной степени тяжести; гипопротеинемия, повышение сывороточного креатинина, мочевины; C-реактивного белка, ферритина, прокальцитонина и D-димера, выявленые в лабораторных анализах. Лечебная тактика включала в себя противовирусную, антибактериальную, антикоагулянтную терапию, кортикостероиды, биологические антицитокиновые препараты. В 95% случаев (n=66) изменялась поддерживающая иммуносупрессивная терапия вплоть до полной отмены определенных компонентов. Выживаемость пациентов с функционирующим трансплантатом составила 76,8% (n=53), потеря трансплантата произошла в 4,3% случаев (n=3), смертельный исход – в 18,8% (n=13). Причиной смерти был тяжелый респираторный дистресс-синдром с полиорганной дисфункцией, осложнившийся у 8 больных (61,5%) сепсисом и септическим шоком. Проведение инвазивной искусственной вентиляции легких повышало риск смерти в 17,2 раза (p<0,00001), необходимость применение гемодиализа – в 21,5 раза (p><0,0006). Выводы. Тяжелая лимфопения связана с клиническим ухудшением течения COVID-19. Выявлены предикторы смертельного исхода: бактериальный сепсис, инвазивная искусственная вентиляция легких, необходимость заместительной почечной терапии. Коррекцию иммуносупрессивной терапии необходимо осуществлять персонализированно с учетом тяжести инфекции, возраста, сопутствующих патологий, срока после трансплантации, а также риска отторжения.> < 0,00001), необходимость применение гемодиализа – в 21,5 раза (p< 0,0006).

Выводы

Выводы. Тяжелая лимфопения связана с клиническим ухудшением течения COVID-19. Выявлены предикторы смертельного исхода: бактериальный сепсис, инвазивная искусственная вентиляция легких, необходимость заместительной почечной терапии. Коррекцию иммуносупрессивной терапии необходимо осуществлять персонализированно с учетом тяжести инфекции, возраста, сопутствующих патологий, срока после трансплантации, а также риска отторжения.

Introduction

Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.

Aim

Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.

Material and methods

Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.

Results

Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p<0.00001) and 21.5 (p<0.0006) times higher risk of death, respectively.

Conclusions

Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p<0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.><0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.

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The authors declare that there are no conflicts of interest present.