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COVID-19在移植中的影响:来自组织病理学的证据

Brian J Nankivell¹, Chow P'ng², Thomas Tran²

¹Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia.

Transplantation

|July 18, 2024

概括

移植患者的SARS-CoV-2感染不会直接损害器官,但会增加排斥的风险. 从COVID-19阳性捐赠者的移植是安全的,没有病毒传播的证据.

科学领域:

腎臟病學 (nephrology) 是一種醫學專業.
病毒学病毒学
移植免疫学移植免疫学

背景情况:

SARS-CoV-2 对移植脏的直接病理影响尚不清楚.
有限的病理学数据存在关于脏全移植中的SARS-CoV-2感染.

研究的目的:

为了评估SARS-CoV-2感染对脏移植活检的生物效应.
为了比较移植的结果涉及捐赠者或接受者与对照对抗COVID-19.

主要方法:

一个单一的中心,503个脏移植活检的前性观察性研究.
对照组包括已死亡的COVID-19捐赠者,SARS-CoV-2 Omicron变异的接受者,BK病毒 (BKV) 感染的样本和未感染的对照.
对管进行了超结构分析和对SARS-CoV-2的分子检测.

主要成果:

在受感染的捐赠者和接受者的移植脏中观察到非病毒性管状损伤;直接的病毒感染被排除为损伤的原因.
在脏组织中没有检测到SARS-CoV-2颗粒,RNA或细胞病变效应.
在COVID-19后接受者的活检显示,与未感染的对照 (13.4%) 相比,排斥的发生率显著更高 (33.0%).
在COVID-19之前是随后移植排斥的独立风险因素 (OR, 2.195).

结论:

从COVID-19阳性已故捐赠者移植的结果是没有病毒传播的受体有利的结果.
在COVID-19中,急性损伤与管状损伤有关,而不是直接的病毒感染.
SARS-CoV-2 感染与随后移植排斥的风险增加有关,类似于 BK 病毒感染.

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