COVID-19と腎臓移植．TANGO国際移植コンソーシアムの結果

COVID-19 and Kidney Transplantation: Results from the TANGO International Transplant Consortium.

• Paolo Cravedi
• Sarvode Mothi Suraj
• Yorg Azzi
• Meredith Haverly
• Samira Farouk
• María José Pérez-Sáez
• Maria Dolores Redondo-Pachón
• Barbara Murphy
• Sander Florman
• Laura Goldfarb Cyrino
• Monica Grafals
• Sandheep Venkataraman
• Xingxing Shelley Cheng
• Aileen Xinqian Wang
• Gianluigi Zaza
• Andrea Ranghino
• Lucrezia Furian
• Joaquin Manrique
• Umberto Maggiore
• Ilaria Gandolfini
• Nikhil Agrawal
• Het Patel
• Enver Akalin
• Leonardo V Riella

抄録

腎移植を受けた患者は、慢性的な免疫抑制と合併症により、COVID-19 の重篤な疾患を発症するリスクが高い可能性がある。我々は、米国、イタリア、スペインの12の移植センターに入院した成人腎移植患者のうち、COVID-19が陽性であった患者を特定した。臨床症状、検査値、免疫抑制、治療戦略を検討し、多変量解析により臨床転帰不良の予測因子を決定した。各施設の腎臓移植患者9,845人のうち、144人が9週間の研究期間中にCOVID-19により入院した。65％が男性で、平均年齢は60（±12）歳、ヒスパニック系40％、アフリカ系アメリカ人25％であった。有病率の高い併存疾患は、高血圧（95％）、糖尿病（52％）、肥満（49％）、心臓（28％）、肺疾患（19％）であった。治療管理は、抗代謝物の休薬（68％）、カルシニューリン阻害剤の休薬（23％）、ヒドロキシクロロキン（71％）、抗生物質（74％）、トシリズマブ（13％）、抗ウイルス剤（14％）であった。追跡期間中央値52日（IQR：16～66日）の間に急性腎障害が52％、挿管を必要とする呼吸不全が29％、死亡率は32％であった。死亡した44例は高齢で、リンパ球数とeGFRが低く、血清乳酸脱水素酵素、プロカルシトニン、IL-6値が高かった。まとめると、COVID-19を有する入院腎移植患者は、急性腎障害と死亡率が高い。

Kidney transplant recipients may be at high risk of developing critical COVID-19 illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the US, Italy and Spain who tested positive for COVID-19. Clinical presentation, laboratory values, immunosuppression and treatment strategies were reviewed and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9,845 kidney transplant recipients across centers, 144 were hospitalized due to COVID-19 during the 9-week study period. 65% were male with a mean age of 60 (±12) years, 40% Hispanic and 25% African-American. Prevalent comorbidities included hypertension (95%), diabetes (52%), obesity (49%), heart (28%) and lung (19%) disease. Therapeutic management included antimetabolite withdrawal (68%), calcineurin inhibitor withdrawal (23%), hydroxychloroquine (71%), antibiotics (74%), tocilizumab (13%) and antivirals (14%). During a median follow-up period of 52 days (IQR: 16-66 days), acute kidney injury occurred in 52% cases, respiratory failure requiring intubation in 29%, and mortality was 32%. The 44 patients who died were older, had lower lymphocyte counts and eGFR, higher serum lactate dehydrogenase, procalcitonin and IL-6 levels. In sum, hospitalized kidney transplant recipients with COVID-19 have higher rates of acute kidney injury and mortality.

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