COVID - LTX BRAZIL

<strong>INTRODUCTION</strong> Amid the current pandemic, consequences of infection in COVID-19 Liver Transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and ethnically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a diverse population of LT recipients. <strong>METHODS</strong> This study was designed as a multi-centric historical cohort, including LT recipient patients with COVID-19 in 25 study centers, with the primary endpoint being COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. <strong>RESULTS</strong> 254 cases were included. The study population was predominantly male, white and had a median age of 60 years. Median time from transplantation was three years (IQR 1-6). Most patients had at least one comorbidity (206, 81%). Patient age was associated with increased mortality (p = 0.04). Dyspnea was correlated with mortality (p &lt; .001), as well as with modifications of immunosuppressive therapy (p &lt; .001), specifically the suspension of immunosuppressive agents. <strong>CONCLUSION</strong> Attention to risk factors and the individualization of patient care, especially regarding immunosuppression management, is crucial for delivering more precise interventions to these individuals.

<strong>引言</strong> 当前新型冠状病毒肺炎疫情大流行背景下，新型冠状病毒感染对肝移植（Liver Transplant, LT）受者的预后结局尤其受到关注，这主要缘于免疫抑制状态与合并症负荷所带来的额外感染风险。目前该领域的相关研究多为样本量偏小、缺乏标准化设计且种族局限性较强的单中心研究。本研究旨在描述多种族肝移植受者群体中新冠病毒感染的临床表现及死亡率升高的诱因。
<strong>方法</strong> 本研究为多中心回顾性队列研究，纳入25家研究中心的新冠病毒感染肝移植受者，主要研究终点为新冠相关死亡。同时收集了受试者的人口学特征、临床表现及疾病进展相关的临床与实验室检查数据。
<strong>结果</strong> 本研究共纳入254例病例。研究队列以男性、白种人为主，中位年龄为60岁。从肝移植至确诊新冠感染的中位时间为3年（四分位间距Interquartile Range, IQR：1~6）。多数患者至少存在1种合并症（206例，占比81%）。患者年龄与死亡率升高呈显著相关性（p=0.04）。呼吸困难与死亡率升高显著相关（p<0.001），同时也与免疫抑制治疗方案调整（p<0.001）——尤其是暂停免疫抑制剂治疗——显著相关。
<strong>结论</strong> 关注相关风险因素并实施个体化患者管理，尤其是免疫抑制治疗方案的优化调整，对于为这类人群提供更精准的干预措施至关重要。