COVID-19'lu böbrek nakli alıcılarının klinik takibi: bir vaka serisi

Year 2022, Volume: 47 Issue: 4, 1746 - 1752, 28.12.2022

Efraim Güzel , Oya Baydar Toprak , Yasemin Saygıdeğer , İsmail Hanta , Saime Paydas , Bülent Kaya , Yeşim Taşova

https://doi.org/10.17826/cumj.1102779

Abstract

COVID-19'un zaman içinde endişe verici oranda küresel bir sağlık sorunu haline geldiği ve belirli risk gruplarında daha ilerleyici ve ölümcül olduğu gözlenmiştir. Bu çalışma, böbrek nakli (RTx) alıcılarında COVID-19'un klinik özelliklerini belirlemeyi ve bu hastaların immünosupresif tedavileri ile COVID-19 tedavi protokollerinin düzenlenmesine katkıda bulunmayı amaçlamaktadır. Çalışmamıza, COVID-19'lu 11 RTx hastası dahil edildi. İmmünosupresif ilaçlar yattığı sürece “antimetabolitlerin kesilmesi, kalsinörin inhibitörerinin kan seviyelerine göre doz ayarlamaları ve kortikosteroidlerin dozunun azaltılması” şeklinde düzenlenerek uygulandı. Hastaneye yatış sonrası ilk basamakta antiviral ilaçlar ve düşük moleküler ağırlıklı heparin verildi. Steroid dozu daha sonra yükseltildi ve klinik kötüleşme durumunda anti-sitokin tedavileri sağlandı. Hastalarımızın yaş ortalaması 50,3±11,2 iken, 8'i (%73) erkekti. Transplantasyondan başvuru zamanına kadar geçen ortalama süre 6,82±3,34 yıldı. Takip sürecimizde COVID-19 progresyonu nedeniyle 8 hastada steroid dozu artırıldı, 5 hastada anakinra ve 1 hastada ise tocilizumab tedaviye eklendi. 5 hastada (%45) yoğun bakım ihtiyacı ortaya çıktı ve bunlardan 3’ne plazmaferez uygulandı. Takip sonunda 9 hastamız tamamen iyileşirken, 2 hastamız (%18,2) öldü. Böbrek nakil alıcılarında COVID-19’un ağır ve ölümcül seyrettiğini literatürle uyumlu şekilde bizim çalışmamızdaki veriler de desteklemektedir. Bu nedenle COVID-19'lu böbrek nakil alıcılarının hastaneye yatırılarak yakından izlenmesi ve klinik koşullara bağlı olarak etkili yönetim tekniklerinin erkenden başlatılması önerilebilir.

Keywords

COVID-19, YBÜ, immunosuppresyon, mortalite, böbrek nakil alıcıları, ICU, immunosuppression, mortality, kidney transplant recipients

Clinical follow up of renal transplant recipients with COVID-19: a case series

Abstract

COVID-19 has been recognized to become a worldwide health concern at an alarming rate over time and to be more progressive and fatal in specific risk populations. This study aims to determine the clinical features of COVID-19 in kidney transplant recipients (KTRxs) and contribute to the regulation of these patients’ immunosuppressive treatments and COVID-19 treatment protocols. The trial comprised eleven KTRxs with COVID-19. Immunosuppressive treatments such as antimetabolite cessation, calcineurin inhibitor dosage adjustments based on blood levels, and low-dose corticosteroids were all controlled. All patients received antiviral medication and low-molecular-weight-heparin (LMWH) as part of initial treatment. The steroid dose was then raised, and anti-cytokine therapies were provided in the setting of clinical worsening. The mean age of the patients was 50.3±11.2 years and 8 (73%) of them were male. The average time since transplantion was 6.82±3.34 years. Due to COVID-19 progression, the steroid dosage was raised in eight patients, anakinra and tocilizumab was added in five and one of the patients respectively. In five (%45) patients, the need for critical care arose and plasmapheresis was used in three of them. At the end of the follow-up, nine of our patients had made a complete recovery, whereas two (18.2%) had perished. Consistent with the literature, the data in presented study may also support the severe and fatal course of COVID-19 in KTRxs. It may be proposed that KTRxs with COVID-19 should be admitted to the hospital and constantly monitored, and certain effective management techniques should be initiated early depending on clinical circumstances.

Keywords

ICU, immunosuppression, mortality, kidney transplant recipients

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