COVID-19 und Nierentransplantation

Abstract

ZusammenfassungNierentransplantierte Patienten stellen während der COVID-19(„coronavirus disease 2019“)-Pandemie eine spezielle Risikogruppe dar. Dies liegt sowohl an den häufig bestehenden Komorbiditäten als auch an der therapeutischen Immunsuppression. Letzterer kommt auch angesichts der stark zu Morbidität und Mortalität beitragenden Hyperinflammation eine komplexe Rolle zu. Bislang publizierte Fallserien zeigen eine hohe Hospitalisierungsrate und eine Mortalität zwischen 13 und 23 % in dieser Population. Die klinische Symptomatik sowie bislang etablierte Risikofaktoren scheinen jenen der Allgemeinbevölkerung zu ähneln. Eine heikle Frage in der Behandlung von an COVID-19 erkrankten Nierentransplantierten ist der Umgang mit der Immunsuppression, welche gemäß aktuellen Empfehlungen stufenweise und in Abhängigkeit vom klinischen Verlauf reduziert werden sollte. Auf der Suche nach wirksamen Therapien gegen SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) wurden zahlreiche in anderen Indikationen etablierte antivirale und antiinflammatorische Substanzen untersucht, wobei bislang nur für die Therapie mit Dexamethason bei Patienten mit Sauerstoffbedarf eine überzeugende Evidenz zu bestehen scheint. Zahllose Studien zu teils auch neuentwickelten Therapien laufen derzeit.

Comparison of all renal replacement therapy modalities in terms of COVID‐19 infection rate & mortality in the COVID‐19 pandemic and importance of home therapies

“…In a meta‐analysis evaluating 1 year of the pandemic, Tx patients exhibited high hospitalization rates of 32% to 97% compared to the normal population; 7% to 32% of the patients had to be followed up in the ICU. Although there are differences between the reported studies, the reported mortality rates in those with COVID‐19 infection are 13% to 32% 22 . Our results according to literature did not support the positive effect of immunosuppressive agents among COVID related mortality 8 .…”

“…Although there are differences between the reported studies, the reported mortality rates in those with COVID-19 infection are 13% to 32%. 22 Our results according to literature did not support the positive effect of immunosuppressive agents among COVID related mortality. 8 The differences among reported rates may vary depending on many factors, such as donor type, age, concomitant diseases, and drugs used.…”

Mucormycosis associated with COVID‐19 in two kidney transplant patients

“…Immunosuppressed patients such as solid organ transplant recipients with SARS-CoV-2 infection have a high risk of developing severe COVID-19, 4 and they present high mortality. 5,6 About 29% of these patients present diffuse alveolar damage requiring mechanical ventilation and admission to the ICU which prolongs hospital stay and increases the chances of developing fungal co-infections. 3,7 In patients with severe COVID-19 infection, there have been reports of an impairment of immunity with up balance of proinflammatory cytokines (IL-1, IL2, IL6, TNFα), disturbance in the lymphocyte Th1 and Th2 responses and lower number of CD4 and CD8 cell counts.…”

COVID-19 ve Böbrek

“…COVID-19 en önemli risk faktörlerinden diabetes mellitus, hipertansiyon, kronik kalp hastalığı, KBH ve immünsüprese hastalar olduğu gösterilmiştir. Ayrıca, hastaneye yatış bakımından aşağıdaki bağımsız risk faktörleri tanımlanmıştır: enfeksiyon anındaki yaş [olasılık oranı (OR) = 1,19, P < 0,0001], vücut kitle indeksi (BMI) >29,9 kg/m2 (OR = 7,21) , P < 0,0001), <7,5 mg prednizolon dozu/gün (OR = 2,29, P = 0,0008) ve koruyucu bir yapıya sahip olan HLA-DQ2 (OR = 0.05, P= 0,0034) olmasıdır (Dedinská et al, 2021;Regele & Oberbauer, 2021). Diğer yandan, literatürde ilk kez, böbrek nakli alıcılarındaki HLA-A10, HLA-B*13, HLA-B*55, HLA-B*57, HLA-DRB1*11 ve HLA-DRB1*13 varlığı SARS-CoV-2 enfeksiyonu ile ilişkili olduğu gösterilmiştir (Ertosun et al, 2021).…”

“…Şiddetli akut solunum sendromu koronavirüs tip 2 (SARS-CoV-2) için etkili bir tedavi arayışına yönelik devam eden çabalar, bilinen antiviral ve anti-inflamatuar maddelerin yeniden kullanılmasına odaklanmaktadır. Bugüne kadar, oksijen takviyesi gerektiren hasta alt grubunda yalnızca deksametazonun etkili bir tedavi olduğu gösterilmiştir; bununla birlikte, yeni terapötik yaklaşımları içeren sayısız deneme devam etmektedir (Regele & Oberbauer, 2021). Dexametazon tedavisi BTx hastalarında etkisi hakkında çelişkili sonuçlar bildirilmiştir (Dheİr et al, 2020).…”