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Zheng Z, Sun H, Hu X, Xuan Z, Fu M, Bai Y, Du Y, Liu B, Sui X, Zheng J, Shao C. Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19. Front Med (Lausanne) 2024; 11:1287836. [PMID: 38633308 PMCID: PMC11021598 DOI: 10.3389/fmed.2024.1287836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 posed a massive threat to human life and caused an economic upheaval worldwide. Kidney transplant recipients (KTRs) became susceptible to infection during the COVID-19 pandemic owing to their use of immunosuppressants, resulting in increased hospitalization and mortality rates. Although the current epidemic situation is alleviated, the long-term existence of COVID-19 still seriously threatens the life and health of KTRs with low immunity. The Omicron variant, a highly infectious but less-pathogenic strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns among transplant physicians regarding managing KTRs diagnosed with this variant. However, currently, there are no clear and unified guidelines for caring for KTRs infected with this variant. Therefore, we aimed to summarize the ongoing research on drugs that can treat Omicron variant infections in KTRs and explore the potential of adjusting immunotherapy strategies to enhance their responsiveness to vaccines. Herein, we discuss the situation of KTRs since the emergence of COVID-19 and focus on various prevention and treatment strategies for KTRs since the Omicron variant outbreak. We hope to assist physicians in managing KTRs in the presence of long-term COVID-19 variants.
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Affiliation(s)
- Zeyuan Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huimin Sun
- Central Laboratory, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoyan Hu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuodong Xuan
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Meiling Fu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yang Bai
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yifan Du
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bin Liu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiuyuan Sui
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Shao
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Muntean M, Briciu V, Lupse M, Colcear D, Macicasan RV, Csiszer A, Manole A, Radulescu A. Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre. Pharmaceuticals (Basel) 2023; 17:3. [PMID: 38275989 PMCID: PMC10820137 DOI: 10.3390/ph17010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to ascertain patient characteristics, outcomes, and liver injuries in patients infected with different SARS-CoV-2 variants. Data from consecutive adult patients with severe/critical COVID-19 admitted to our hospital during the peak month of the Delta wave were compared to the ancestral, Alpha, and Omicron waves. The dataset of 551 hospitalized patients was similar in the Delta/non-Delta waves. At admission and discharge, the median aminotransferase levels were normal or slightly increased. During the Delta wave (172 vs. 379 non-Delta patients), more patients died (OR 1.69, 95%CI 1.09-2.56) or had liver injury at discharge (alanine aminotransferase, ALT ≥ 2 ULN) (OR 1.97, 95%CI 1.08-3.54). In-hospital mortality was associated with age, lung injury, intensive care unit admission, number of and cardiovascular comorbidities, diabetes, chronic kidney disease, and all inflammatory biomarkers. Serious liver injury at admission (ALT ≥ 5 × ULN) was significantly associated with in-hospital mortality (OR = 7.9, 95%CI 2-28.9). At discharge, drug-induced liver injury (DILI) was found in patients treated with remdesivir, ALT ≥ 2 ULN (OR = 2.62, 95%CI 1.22-5.75). Treatment with dexamethasone, remdesivir, and immunomodulators showed improved survival, OR = 0.50 (95%CI 0.33-0.77). Regardless of the variant and treatment options, less than 2% of patients displayed serious liver injury, which was not found to be a death predictor in multivariable analysis.
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Affiliation(s)
- Monica Muntean
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Violeta Briciu
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Mihaela Lupse
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Doina Colcear
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
| | - Raul Vlad Macicasan
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Agnes Csiszer
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Alexandra Manole
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
| | - Amanda Radulescu
- Department of Infectious Diseases and Epidemiology, The “Iuliu Hatieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania; (M.M.); (M.L.); (R.V.M.); (A.C.); (A.M.); (A.R.)
- The Teaching Hospital of Infectious Diseases, 400348 Cluj-Napoca, Romania;
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