摘要
目的总结尸体供肝肝移植前后感染新型冠状病毒(SARS-CoV-2)的诊治经验。方法回顾性分析山西医科大学第一医院自2022年11月至2023年1月收治的感染新型冠状病毒(SARS-CoV-2)的5例尸体供肝肝移植受者的临床资料。同时分别以"肝移植"和"新型冠状病毒","liver transplantation"和"2019 novel coronavirus"或"SARS-CoV-2"为中英文关键词,对中国知网、万方数据库、PubMed自建库至2023年2月的相关文献进行检索,结合上述5例受者的相关资料,总结感染新型冠状病毒(SARS-CoV-2)的发病情况、肝移植手术适应证,术前术后诊治经验。结果5例肝移植受者中,2例分别于术前14 d和20 d进行SARS-CoV-2 RT-PCR检测结果呈阳性,术前检查转阴,无临床症状且胸部CT检查提示无肺炎表现,移植术后未出现感染等并发症。3例分别是术后1 d、10 d和16 d行SARS-CoV-2 RT-PCR检测呈阳性,其中1例术后感染病例在感染后11 d再次出现发热,体温最高达39.5度,并迅速进展为心、肺、肾等多器官功能衰竭,经积极治疗后器官功能逐渐恢复,另2例经治疗后SARS-CoV-2 RT-PCR检测呈阴性,至随访截止,所有受者均健康存活。文献检索最终找到符合条件的英文文献9篇,未检索到中文文献,共15例感染SARS-CoV-2的肝移植受者,其中1例因感染性休克死亡,1例因移植肝功能衰竭死亡,其余均存活。结论感染SARS-CoV-2的肝移植受者,术前RT-PCR转阴,接受移植手术是可行的。对于移植术后早期SARS-CoV-2感染的受者,严密监测心、肺、肝、肾等重要器官功能,及时抗病毒治疗,减少免疫抑制的使用,可以获得良好的预后。
Objective To explore the effects of novel coronaviral infection on the outcomes of liver transplantation recipients.Methods The relevant clinical data were retrospectively reviewed for 5 liver transplantation recipients infected with novel coronavirus during perioperative period at First Hospital of Shanxi Medical University.At the same time,"liver transplantation"and"novel coronavirus"and"2019 novel coronavirus"or"SARS-CoV-2"were employed as Chinese and English keywords respectively for searching the relevant literature items of CNKI,Wanfang and PubMed from the inception of database until February 2023.The impact of perioperative novel coronaviral infection was examined on the outcomes of liver transplantation recipients.Results From November 2022 to January 2023,liver transplantation was performed in 5 recipients of donated liver after death.Two cases tested positive for real-time polymerase chain reaction(RT-PCR)at Day 14/20 pre-operation and converted into negative post-operation.Three cases were infected with SARS-CoV-2 at Day 1/10/16 post-operation.And one of them became feverish again at Day 11 post-infection.With a peak temperature of 39.5 degrees,it rapidly progressed into multiple organ failures of heart,lung and kidney.After active interventions,organ function gradually recovered.Through literature searches,9 eligible English literature items were retrieved.However,there was no Chinese entry.Among 15 liver transplantation recipients with SARS-CoV-2 infection,one died from septic shock,another from graft failure and the remainders survived.Conclusions liver transplantation recipients infected with SARS-CoV-2 and negative RT-PCR pre-operation are asymptomatic.Without signs of pneumonia on chest CT,transplantation may be performed.For post-liver transplantation recipients with early SARS-CoV-2 infection,close monitoring of important organ functions such as heart,lung,liver and kidney,timely antiviral regimen and tapered use of immunosuppression can achieve a decent prognosis.
作者
张瑞
张和钊
史志勇
张安红
徐钧
Zhang Rui;Zhang Hezhao;Shi Zhiyong;Zhang Anhong;Xu Jun
出处
《中华器官移植杂志》
CAS
2023年第11期682-688,共7页
Chinese Journal of Organ Transplantation
基金
山西省科学技术厅(YDZJSX2021B0)
山西省卫生健康委员会(2020TD08)。
关键词
肝移植
新型冠状病毒
感染
Liver transplantation
Novel coronavirus
Infection
