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中华移植杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 65 -81. doi: 10.3877/cma.j.issn.1674-3903.2023.02.001

所属专题: 指南共识

专家共识

实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版)
国家传染病医学中心, 中华医学会器官移植学分会, 中国康复医学会器官移植康复专业委员会, 中国器官移植发展基金会器官移植受者健康管理专项基金   
  • 收稿日期:2023-02-10 出版日期:2023-04-25
  • 基金资助:
    上海申康医院发展中心临床三年行动计划(SHDC2020CR2021B); 国家自然科学基金专项项目(82241225); 上海市重大专项(HS2021SHZX001)

Expert Consensus on the Management of COVID-19 in Solid Organ Transplant Recipients (2023 edition)

National Center for Infectious Diseases, Chinese Medical Association Organ Transplantation Branch, Organ Transplantation Rehabilitation Committee of the China Society of Rehabilitation Medicine, Special Fund for Health Management of Organ Transplant Recipients of the China Organ Transplantation Development Foundation   

  • Received:2023-02-10 Published:2023-04-25
引用本文:

国家传染病医学中心, 中华医学会器官移植学分会, 中国康复医学会器官移植康复专业委员会, 中国器官移植发展基金会器官移植受者健康管理专项基金. 实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版)[J]. 中华移植杂志(电子版), 2023, 17(02): 65-81.

National Center for Infectious Diseases, Chinese Medical Association Organ Transplantation Branch, Organ Transplantation Rehabilitation Committee of the China Society of Rehabilitation Medicine, Special Fund for Health Management of Organ Transplant Recipients of the China Organ Transplantation Development Foundation. Expert Consensus on the Management of COVID-19 in Solid Organ Transplant Recipients (2023 edition)[J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(02): 65-81.

自2019年底以来,新型冠状病毒(新冠病毒)感染大流行已席卷全球。虽然目前的新冠病毒变异株的致病性和毒力已较原始株有所下降,大多数患者预后良好,但实体器官移植(SOT)受者人群为新冠病毒感染脆弱人群,即使全程接种新冠病毒疫苗,SOT受者感染新冠病毒的住院或死亡风险依然较高。SOT受者新冠病毒感染后其临床表现、诊断和治疗均与普通人群存在很大的特殊性,需要高度关注。目前尚缺乏针对SOT受者人群可供参考的新冠病毒感染诊疗领域的指南或共识。因此,参考《新型冠状病毒诊疗方案(试行第十版)》及国内外文献,编写团队撰写了《实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版)》。本共识基于国内外新冠病毒感染的循证医学证据,并经过专家多次研讨达成一致意见后撰写成文,形成21条推荐意见,为SOT受者感染新冠病毒的诊疗提供参考。

Since the end of 2019, the novel coronavirus infection pandemic has swept the world. Although the current novel coronavirus mutants have decreased in pathogenicity and virulence compared with the original strains, and most patients have a good prognosis, the solid organ transplant (SOT) recipients are vulnerable to novel coronavirus. And even with vaccination, the risk of hospitalization or death is still high in SOT recipients infected with novel coronavirus. What′s more, the clinical manifestations, diagnosis and treatment strategy of SOT recipients infected with novel coronavirus has its unique features, which need high attention. At present, there is a lack of guidelines or consensus in the diagnosis and treatment field of novel coronavirus for such a large number of SOT recipients. Therefore, referring to the "Diagnosis and treatment plan of coronavirus (Trial Version 10)" and global published literature, the writing team wrote the "Expert consensus on diagnosis and treatment of novel coronavirus infection in solid organ transplant recipients (2023 edition)" . This consensus was evidence-based written and reached by experts after multiple rounds of discussions, forming 21 recommendations, providing reference for the diagnosis and treatment of SOT recipients infected with novel coronavirus.

表1 2009牛津大学证据分级与推荐意见强度分级标准
表2 推荐意见汇总
序号 推荐意见 推荐强度 证据等级
1 SOT受者对新冠病毒普遍易感。目前没有证据证明SOT受者新冠病毒感染的潜伏期与其他新冠病毒感染者有差异。SOT受者感染新冠病毒,在潜伏期即具有传染性,由于SOT受者感染新冠病毒的排毒期更长,其具有传染性的时间更长 B 2a
2 SOT受者感染新冠病毒的症状与普通人群相似,主要临床表现为发热、乏力和肌痛,还有一些患者表现为咽痛、咳嗽、呼吸短促、腹泻、头晕头痛、失嗅症和厌食等。需警惕SOT受者因使用免疫抑制剂导致早期症状隐匿而后期病情进展较快。尤其需要警惕SOT受者腹泻导致免疫抑制剂药物浓度的变化,需要密切监测血药浓度 B 2a
3 SOT受者感染新冠病毒后,相较于普通人群,重型/危重型发生率和病死率更高。高龄和基础合并症多的SOT受者新冠病毒感染的预后可能更差 B 2a
4 SOT受者二次感染新冠病毒的风险较高,仍需要加强防护 B 2b
5 SOT受者如果有流行病学史,且出现发热等与新冠病毒感染一致的症状,应立即进行新冠病毒核酸或抗原检测。在病程最初5~7天内检测,阳性率较高。在确诊6天后,可定期检测新冠病毒核酸或抗原以评估患者新冠病毒是否转阴(2次采样至少间隔24小时) B 2a
6 低氧血症进行性加重、外周血淋巴细胞进行性减少、炎症生物标志物和细胞因子水平升高、D-二聚体等凝血功能相关指标持续异常、乳酸脱氢酶、天冬氨酸转氨酶、丙氨酸转氨酶、肌酸激酶、高敏肌钙蛋白等指标明显升高、胸部影像学显示肺部病变明显进展,以及移植物功能不全是SOT受者感染新冠病毒后发生重型或危重型的重要预警指标 B 2a
7 SOT受者在感染新冠病毒后,合并或继发细菌和(或)真菌感染风险增高,应尽早进行相关实验室检测、留取标本培养及完善胸部影像学检查 B 2b
8 对于SOT受者,一旦出现新冠病毒感染的症状,应尽早在专科医师指导下明确诊断、评估各项生命体征和高危预警实验室指标,并完善胸部影像学检查,综合患者病情调整免疫抑制剂的剂量,符合抗新冠病毒治疗条件的患者应尽早使用抗新冠病毒药物。对于中型、重型或危重型患者,建议住院治疗,在制订SOT受者感染新冠病毒后的治疗方案时,要注意抗新冠病毒药物与免疫抑制剂的相互作用 B 2b
9 SOT是轻型和中型新冠病毒感染患者进展为重型或危重型的高风险因素之一,应结合患者病程、病情及基础用药情况,尽早合理地选用抗新冠病毒药物,抑制病毒复制并控制病毒感染进程 A 1a
  对于重型和危重型患者,若新冠病毒核酸阳性(Ct值≤30),亦建议使用抗病毒药物治疗 D 5
10 SOT受者易出现新冠病毒核酸持续阳性(Ct值≤30),在评估获益风险比后,可适当延长小分子药物抗病毒疗程。在病情治疗需要的情况下,可以尝试换用或者联用其他不同作用机制的抗病毒药物治疗 D 5
11 SOT受者新冠病毒感染发生炎症反应的免疫治疗总体可参考普通人群诊疗指南 D 5
12 对于新冠病毒感染轻型的SOT受者,建议维持原有的免疫抑制方案 B 3a
  对于新冠病毒感染中型的SOT受者,建议减少或停用霉酚酸类药物,综合评估病情后个体化调整钙调磷酸酶抑制剂或雷帕霉素靶蛋白抑制剂方案 B 2b
  对于新冠病毒感染重型或危重型的SOT受者,应停用所有非激素类免疫抑制剂 D 5
13 在使用奈玛特韦/利托那韦或先诺特韦/利托那韦时应注意其与免疫抑制剂的相互作用,注意调整钙调磷酸酶抑制剂、雷帕霉素靶蛋白抑制剂和糖皮质激素的剂量,密切监测药物浓度 B~C 2c~4
  在使用莫诺拉韦、阿兹夫定、氢溴酸氘瑞米德韦、巴瑞替尼或托珠单抗时,初始无需调整免疫抑制剂剂量,但仍应加强药物浓度监测,同时不建议巴瑞替尼或托珠单抗与巴利昔单抗联用,警惕增加免疫抑制风险 D 5
14 在使用奈玛特韦/利托那韦、先诺特韦/利托那韦和阿兹夫定时,应注意其与抗菌药物的相互作用,注意药物联合使用的禁忌 B~C 2c~4
  在使用莫诺拉韦、氢溴酸氘瑞米德韦、巴瑞替尼或托珠单抗时,初始无需调整抗菌药物剂量,但仍应加强药物浓度监测 D 5
15 对于重型或危重型高危人群、病情进展较快的中型病例以及重型或危重型病例,无禁忌情况下推荐预防剂量低分子肝素或者普通肝素进行预防性抗凝;治疗性抗凝适用于确诊血栓形成的患者。如使用利伐沙班等其他抗凝方案,应注意抗凝药物与抗新冠病毒药物的相互作用 B 2a
16 可使用没有出现免疫逃逸的中和抗体药物,联合小分子抗病毒药物对具有较高风险因素的感染新冠病毒的SOT受者进行治疗 A 1a
17 感染新冠病毒的SOT受者,呼吸支持策略与普通肺部感染患者基本类似。根据患者的病情,可以选择普通氧疗(鼻导管、普通面罩、文丘里面罩或非重复呼吸储氧面罩等)、经鼻高流量氧疗、无创正压通气、有创正压通气和体外膜肺氧合。氧疗目标:(1)无高碳酸血症风险患者,脉搏血氧饱和度92%~96%;(2)高碳酸血症高风险患者,脉搏血氧饱和度88%~92% B 2b
  具有重症化危险因素、病情进展较快的中型、重型和危重型病例,应当早期给予规范的俯卧位通气治疗,建议每日不少于12小时 B 2b
18 推荐SOT等待者在移植前2周完成全程新冠病毒疫苗接种。推荐SOT手术4周后可酌情接受除了减毒活疫苗以外的新冠疫苗接种 D 5
  若SOT受者接受T细胞或B细胞消除治疗(如使用抗胸腺细胞球蛋白或利妥昔单抗),结束治疗12周后可接受新冠病毒疫苗接种 D 5
  SOT受者接种新冠病毒疫苗,可降低其感染新冠病毒后重症化的风险 C 4
19 可使用没有出现免疫逃逸的中和抗体药物,在区域疫情流行时,对暴露后的SOT受者进行新冠病毒感染的预防 A 1a
  接受B细胞耗竭剂治疗的SOT受者,可适当予以暴露前中和抗体预防 B 3a
20 对于新冠病毒感染患者,不建议进行非抢救性SOT。对于抢救性SOT,需经过多学科讨论权衡利弊后决定 D 5
21 出院指导和随访基本同移植术后,需补充新冠病毒防护的相关内容。推荐在移植科医师指导下进行规律随访 A 1b
表3 抗病毒药物与免疫抑制剂的相互作用
抗病毒药物 免疫抑制剂 药物相互作用原理及剂量调整方案
奈玛特韦/利托那韦(paxlovid) 他克莫司 合用可显著增加他克莫司血药浓度
在paxlovid治疗的第1天,给予他克莫司常规日剂量的1/8,然后停止;第6天给予1/2日剂量;第7天给予3/4日剂量;第8天重启常规日剂量
注意事项:在治疗期间的第3天监测他克莫司浓度,并评估患者免疫状态
  环孢素 合用可显著增加环孢素血药浓度
在paxlovid治疗期间,每日给予环孢素常规日剂量的1/5;第6天给予1/2日剂量;第7天给予3/4日剂量;第8天重启常规日剂量
  MPA 无显著药物相互作用,无需调整剂量
  mTOR抑制剂 联合给药可增加mTOR抑制剂血药浓度
在使用paxlovid前12小时停用mTOR抑制剂。paxlovid治疗结束后第2天mTOR抑制剂以原始剂量的20%重新使用,每日增加20%,并根据检测的mTOR抑制剂血药谷浓度调整剂量
  糖皮质激素 合用可能会增加糖皮质激素的暴露量,但相互作用弱,可以不调整糖皮质激素剂量
先诺特韦/利托那韦 免疫抑制剂 药物相互作用数据尚缺,但先诺特韦作用机制与奈玛特韦相似,可以参考奈玛特韦/利托那韦调整药物剂量
阿兹夫定 免疫抑制剂 无显著药物相互作用,无需调整剂量,但需监测药物浓度
莫诺拉韦 免疫抑制剂 无显著药物相互作用,无需调整剂量
氢溴酸氘瑞米德韦 免疫抑制剂 无显著药物相互作用,无需调整剂量
表4 抗病毒药物与SOT继发感染时常用的抗生素药物相互作用
1
World Health Organization. WHO Expert Committee on Specifications for Pharmaceutical Preparations: Forty-eighth Report[M]. World Health Organization, 2014:401.
2
蒋朱明,詹思延,贾晓巍,等. 制订/修订《临床诊疗指南》的基本方法及程序[J]. 中华医学杂志2016, 96(4):250-253.
3
Brouwers MC, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18):E839-E842.
4
Chen YL, Yang K, Marušić A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement[J]. Ann Intern Med, 2017, 166(2):128-132.
5
Centre for Evidence-Based Medicine (CEBM), University of Oxford. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009)[DB/OL]. [2023-02-01].

URL    
6
Liu HL, He X, Wang YD, et al. Management of COVID-19 in patients after liver transplantation: Beijing working party for liver transplantation[J]. Hepatol Int, 2020, 14(4):432-436.
7
Fraser J, Mousley J, Testro A, et al. Clinical presentation, treatment, and mortality rate in liver transplant recipients with coronavirus disease 2019: A systematic review and quantitative analysis[J]. Transplant Proc, 2020, 52(9):2676-2683.
8
Wong GLH, Wong VWS, Thompson A, et al. Management of patients with liver derangement during the COVID-19 pandemic: an Asia-Pacific position statement[J]. Lancet Gastroenterol Hepatol, 2020, 5(8):776-787.
9
Ma E, Ai JW, Zhang Y, et al. Omicron infections profile and vaccination status among 1881 liver transplant recipients: A multi-centre retrospective cohort[J]. Emerg Microbes Infect, 2022, 11(1):2636-2344.
10
Raja MA, Mendoza MA, Villavicencio A, et al. COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature[J]. Transplant Rev (Orlando), 2021, 35(1):100588.
11
Jayant K, Reccia I, Virdis F, et al. COVID-19 in hospitalized liver transplant recipients: an early systematic review and meta-analysis[J]. Clin Transplant, 2021, 35(4):e14246.
12
Duarsa GWK, Sugianto R, Yusari IGAAA, et al. Predictor factor for worse outcomes in kidney transplant recipients infected with coronavirus disease 2019: a systematic review and meta-analysis[J]. Transpl Immunol, 2023, 76:101739.
13
Kulkarni AV, Tevethia HV, Premkumar M, et al. Impact of COVID-19 on liver transplant recipients-a systematic review and meta-analysis[J]. EClinicalMedicine, 2021, 38:101025.
14
Bansal A, Kumar A, Bansal RM, et al. The impact of comorbidities on clinical course and outcome, in kidney transplant recipients with COVID-19: a systematic review and analysis[J]. Indian J Transpl, 2020, 14(4):275.
15
Bartelt L, van Duin D. An overview of COVID-19 in solid organ transplantation[J]. Clin Microbiol Infect, 2022, 28(6):779-784.
16
Kremer D, Pieters TT, Verhaar MC, et al. A systematic review and meta-analysis of COVID-19 in kidney transplant recipients: lessons to be learned[J]. Am J Transplant, 2021, 21(12):3936-3945.
17
Mahalingasivam V, Craik A, Tomlinson LA, et al. A systematic review of COVID-19 and kidney transplantation[J]. Kidney Int Rep, 2021, 6(1):24-45.
18
An W, Wang Q, Kim TE, et al. Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: a systematic review and meta-analysis[J]. J Infect Public Health, 2022, 15(3):365-372.
19
Ho QY, Sultana R, Lee TL, et al. Coronavirus disease 2019 in kidney transplant recipients: a systematic review and meta-analysis[J]. Singapore Med J, 2021.
20
Moosavi SA, Mashhadiagha A, Motazedian N, et al. COVID-19 clinical manifestations and treatment strategies among solid-organ recipients: a systematic review of cases[J]. Transpl Infect Dis, 2020, 22(6):e13427.
21
Diaz-Arocutipa C, Carvallo-Castañeda D, Luis-Ybañez O, et al. COVID-19 in heart transplant recipients during February-August 2020: a systematic review[J]. Clin Transplant, 2021, 35(9):e14390.
22
Morris S, Anjan S, Pallikkuth S, et al. Reinfection with SARS-CoV-2 in solid-organ transplant recipients: incidence density and convalescent immunity prior to reinfection[J]. Transpl Infect Dis, 2022, 24(3):e13827.
23
Vitale J, Mumoli N, Clerici P, et al. Assessment of SARS-CoV-2 reinfection 1 year after primary infection in a population in Lombardy, Italy[J]. JAMA Intern Med, 2021, 181(10):1407-1408.
24
Medić S, Anastassopoulou C, Lozanov-Crvenković Z, et al. Risk and severity of SARS-CoV-2 reinfections during 2020-2022 in Vojvodina, Serbia: a population-level observational study[J]. Lancet Reg Health Eur, 2022, 20:100453.
25
Qureshi AI, Baskett WI, Huang W, et al. Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients undergoing serial laboratory testing[J]. Clin Infect Dis, 2022, 74(2):294-300.
26
中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版) [EB/OL].(2023-01-06)[2023-02-01].

URL    
27
World Health Organization. Public health surveillance for COVID-19: interim guidance, 22 July 2022[DB/OL]. (2022-07-22) [2023-01-30].

URL    
28
中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第九版)[EB/OL].(2022-03-14)[2023-02-01].

URL    
29
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens[J]. JAMA, 2020, 323(18):1843-1844.
30
Marjot T, Webb GJ, Barritt AS, et al. COVID-19 and liver disease: mechanistic and clinical perspectives[J]. Nat Rev Gastroenterol Hepatol, 2021, 18(5):348-364.
31
Chen ZF, Xu WJ, Ma WS, et al. Clinical laboratory evaluation of COVID-19[J]. Clin Chim Acta, 2021, 519:172-182.
32
Karakoyun I, Colak A, Turken M, et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients[J]. Int Immunopharmacol, 2021, 91:107285.
33
Liu XK, Yue XP, Liu FR, et al. Analysis of clinical features and early warning signs in patients with severe COVID-19: a retrospective cohort study[J/OL]. PLoS One, 2020, 15(6):e0235459.
34
Wang XR, Che QL, Ji XX, et al. Correlation between lung infection severity and clinical laboratory indicators in patients with COVID-19: a cross-sectional study based on machine learning[J]. BMC Infect Dis, 2021, 21(1):192.
35
Guo J, Wang S, Xia H, et al. Cytokine signature associated with disease severity in COVID-19[J]. Front Immunol, 2021, 12:681516.
36
Mitchell O, Cosar AM, Malik MU, et al. Late liver function test abnormalities post-adult liver transplantation: a review of the etiology, investigation, and management[J]. Hepatol Int, 2016, 10(1):106-114.
37
Wadei HM, Lee DD, Croome KP, et al. Early allograft dysfunction after liver transplantation is associated with short- and long-term kidney function impairment[J]. Am J Transplant, 2016, 16(3):850-859.
38
Buchan TA, Moayedi Y, Truby LK, et al. Incidence and impact of primary graft dysfunction in adult heart transplant recipients: a systematic review and meta-analysis[J]. J Heart Lung Transplant, 2021, 40(7):642-651.
39
Shah RJ, Diamond JM. Primary graft dysfunction (PGD) following lung transplantation[J]. Semin Respir Crit Care Med, 2018, 39(2):148-154.
40
Bhat KA, Madi D, Bhat S, et al. Profile of secondary bacterial and fungal infections in hospitalized COVID-19 patients in a tertiary care centre[J]. Infect Drug Resist, 2022, 15:5705-5714.
41
Patel P, DeCuir J, Abrams J, et al. Clinical characteristics of multisystem inflammatory syndrome in adults: a systematic review[J]. JAMA Netw Open, 2021, 4(9):e2126456.
42
Weiss-Tessbach M, Ratzinger F, Obermueller M, et al. Biomarkers for differentiation of coronavirus disease 2019 or extracorporeal membrane oxygenation related inflammation and bacterial/fungal infections in critically ill patients: a prospective observational study[J]. Front Med (Lausanne), 2022, 9:917606.
43
Nimmo A, Gardiner D, Ushiro-Lumb I, et al. The global impact of COVID-19 on solid organ transplantation: two years into a pandemic[J]. Transplantation, 2022, 106(7):1312-1329.
44
APASL Covid-19 Task Force, Lau G, Sharma M. Clinical practice guidance for hepatology and liver transplant providers during the COVID-19 pandemic: APASL expert panel consensus recommendations[J]. Hepatol Int, 2020, 14(4):415-428.
45
Gandolfini I, Crespo M, Hellemans R, et al. Issues regarding COVID-19 in kidney transplantation in the ERA of the Omicron variant: a commentary by the ERA Descartes Working Group[J]. Nephrol Dial Transplant, 2022, 37(10):1824-1829.
46
Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for high-risk, nonhospitalized adults with Covid-19[J]. N Engl J Med, 2022, 386(15):1397-1408.
47
阿兹夫定片说明书[EB/OL]. [2023-02-01].

URL    
48
Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients[J]. N Engl J Med, 2022, 386(6):509-520.
49
Cao Z, Gao W, Bao H, et al. VV116 versus Nirmatrelvir-Ritonavir for oral treatment of Covid-19[J]. N Engl J Med, 2023, 388(5):406-417.
50
Helleberg M, Niemann CU, Moestrup KS, et al. Persistent COVID-19 in an immunocompromised patient temporarily responsive to two courses of Remdesivir therapy[J]. J Infect Dis, 2020, 222(7):1103-1107.
51
Trottier CA, Wong B, Kohli R, et al. Dual antiviral therapy for persistent COVID-19 and associated organizing pneumonia in an immunocompromised host[J]. Clin Infect Dis, 2022:ciac847.
52
Martinez MA, Chen TY, Choi H, et al. Extended Remdesivir infusion for persistent coronavirus disease 2019 infection[J]. Open Forum Infect Dis, 2022, 9(8):ofac382.
53
Dosing & Side Effects. Olumiant® (baricitinib)[EB/OL]. [2023-02-01].

URL    
54
Tocilizumab (Actemra) [EB/OL]. [2023-02-01].

URL    
55
Yin S, Wang X, Song T. Tacrolimus use and COVID-19 infection in patients after solid organ transplantation[J]. Gastroenterology, 2021, 161(2):728-730.e1.
56
Kolonko A, Kuczaj AA, Musialik J, et al. Clinical insights into the role of immunosuppression in solid organ transplant recipients with COVID-19[J]. Pol Arch Intern Med, 2022, 132(2):16139.
57
Belli LS, Fondevila C, Cortesi PA, et al. Protective role of Tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR Multi-center European Study[J]. Gastroenterology, 2021, 160(4):1151-1163.e3.
58
Karruli A, Spiezia S, Boccia F, et al. Effect of immunosuppression maintenance in solid organ transplant recipients with COVID-19: systematic review and meta-analysis[J]. Transpl Infect Dis, 2021, 23(4):e13595.
59
Colmenero J, Rodríguez-Perálvarez M, Salcedo M, et al. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients[J]. J Hepatol, 2021, 74(1):148-155.
60
Yadav DK, Adhikari VP, Ling Q, et al. Immunosuppressants in liver transplant recipients with coronavirus disease 2019: capability or catastrophe?-a systematic review and meta-analysis[J]. Front Med (Lausanne), 2021, 8:756922.
61
Lemaitre F, Budde K, Van Gelder T, et al. Therapeutic drug monitoring and dosage adjustments of immunosuppressive drugs when combined with nirmatrelvir/ritonavir in patients with COVID-19[J]. Ther Drug Monit, 2022.
62
Lemaitre F, Grégoire M, Monchaud C, et al. Management of drug-drug interactions with nirmatrelvir/ritonavir in patients treated for Covid-19: guidelines from the French Society of Pharmacology and Therapeutics (SFPT) [J]. Therapie, 2022, 77(5):509-521.
63
Lange NW, Salerno DM, Jennings DL, et al. Nirmatrelvir/ritonavir use: managing clinically significant drug-drug interactions with transplant immunosuppressants[J]. Am J Transplant, 2022, 22(7):1925-1926.
64
Salerno DM, Jennings DL, Lange NW, et al. Early clinical experience with nirmatrelvir/ritonavir for the treatment of COVID-19 in solid organ transplant recipients[J]. Am J Transplant, 2022, 22(8):2083-2088.
65
Devresse A, Sébastien Briol, De Greef J, et al. Safety, efficacy, and relapse of Nirmatrelvir-Ritonavir in kidney transplant recipients infected with SARS-CoV-2[J]. Kidney Int Rep, 2022, 7(11):2356-2363.
66
Liu Y, Liu B, Zhang Y, et al. Intestinal absorption mechanisms of 2′-deoxy-2′-β-fluoro-4′-azidocytidine, a cytidine analog for AIDS treatment, and its interaction with P-glycoprotein, multidrug resistance-associated protein 2 and breast cancer resistance protein[J]. Eur J Pharm Sci, 2017, 105:150-158.
67
Liu Y, Wang Y, Peng Y, et al. Effects of the antiretroviral drug 2′-deoxy-2′-β-fluoro-4′-azidocytidine (FNC) on P-gp, MRP2 and BCRP expressions and functions[J]. Pharmazie, 2018, 73(9):503-507.
68
Hirai T, Mizuta A, Sasaki T, et al. Drug-drug interaction between remdesivir and immunosuppressant agents in a kidney transplant recipient[J]. Int J Clin Pharmacol Ther, 2022, 60(10):439-444.
69
Nakamura J, Yanagida M, Saito K, et al. Epstein-barr virus encephalitis in a patient with rheumatoid arthritis[J]. Mod Rheumatol Case Rep, 2022, 6(2):160-162.
70
Sugawara E, Matsui K, Amasaki Y. Cytomegalovirus enteritis in a patient with rheumatoid arthritis receiving Baricitinib[J]. J Rheumatol, 2020, 47(12):1835-1836.
71
Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in hospitalized patients with COVID-19 in a New York City Health System[J]. JAMA, 2020, 324(8):799-801.
72
Menter T, Haslbauer JD, Nienhold R, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction[J]. Histopathology, 2020, 77(2):198-209.
73
Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19[J]. J Thromb Haemost, 2020, 18(8):1995-2002.
74
Nicolai L, Leunig A, Brambs S, et al. Immunothrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy[J]. Circulation, 2020, 142(12):1176-1189.
75
Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study[J]. Ann Intern Med, 2020, 173(4):268-277.
76
Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19[J]. N Engl J Med, 2020, 383(25):2451-2460.
77
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study[J]. Lancet, 2020, 395(10229):1054-1062.
78
Cui S, Chen S, Li X, et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia[J]. J Thromb Haemost, 2020, 18(6):1421-1424.
79
Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19[J]. Thromb Res, 2020, 191:145-147.
80
Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy[J]. Thromb Res, 2020, 191:9-14.
81
Nadkarni GN, Lala A, Bagiella E, et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19[J]. J Am Coll Cardiol, 2020, 76(16):1815-1826.
82
Task Force for the management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up[J]. Eur Heart J, 2022, 43(11):1059-1103.
83
Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19[J]. J Thromb Haemost, 2020, 18(5):1023-1026.
84
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2020, 75(23):2950-2973.
85
Hoy SM. Amubarvimab/Romlusevimab: first approval[J]. Drugs, 2022, 82(12):1327-1331.
86
ACTIV-3/Therapeutics for Inpatients with COVID-19 (TICO) Study Group. Efficacy and safety of two neutralising monoclonal antibody therapies, sotrovimab and BRII-196 plus BRII-198, for adults hospitalised with COVID-19 (TICO): a randomised controlled trial[J]. Lancet Infect Dis, 2022, 22(5):622-635.
87
中华医学会呼吸病学分会,中国医师协会呼吸医师分会危重症医学专家组. 奥密克戎变异株所致重症新型冠状病毒感染临床救治专家推荐意见[J]. 中华结核和呼吸杂志2023, 46(2):101-110.
88
Siemieniuk RAC, Chu DK, Kim LHY, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline[J]. BMJ, 2018, 363:k4169.
89
Nevermann N, Wiering L, Wu H, et al. Transplantation programs facing lack of empirical evidence on SARS-CoV-2 vaccination: a society recommendation consensus update[J]. Transpl Infect Dis, 2021, 23(4):e13696.
90
National Institutes of Health. Special considerations in solid organ transplant, hematopoietic cell transplant, and cellular immunotherapy candidates, donors, and recipients. COVID-19 Treatment Guidelines[EB/OL]. (2022-12-01) [2023-02-01].

URL    
91
AST, ASTS, ISHLT. Joint statement about COVID-19 vaccination in organ transplant candidates and recipients [EB/OL]. (2022-12-01) [2023-02-01].

URL    
92
WHO. Who needs an additional dose of COVID-19 vaccines?[EB/OL]. (2022-05-17) [2023-02-01].

URL    
93
中华人民共和国国家卫生健康委员会. 新冠病毒疫苗接种技术指南(第一版)[EB/OL].(2021-03-29)[2023-02-01].

URL    
94
Cohen MS, Nirula A, Mulligan MJ, et al. Effect of Bamlanivimab vs Placebo on incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities: a randomized clinical trial[J]. JAMA, 2021, 326(1):46-55.
95
Levin MJ, Ustianowski A, De Wit S, et al. Intramuscular AZD7442 (Tixagevimab-Cilgavimab) for prevention of Covid-19[J]. N Engl J Med, 2022, 386(23):2188-200.
96
Shields AM, Burns SO, Savic S, et al; UK PIN COVID-19 Consortium. COVID-19 in patients with primary and secondary immunodeficiency: the United Kingdom experience[J]. J Allergy Clin Immunol, 2021, 147(3):870-875.e1.
97
Calabrese C, Kirchner E, Villa-Forte A, et al. Early experience with tixagevimab/cilgavimab pre-exposure prophylaxis in patients with immune-mediated inflammatory disease undergoing B cell depleting therapy and those with inborn errors of humoral immunity[J]. RMD Open, 2022, 8(2):e002557.
98
Ritschl PV, Nevermann N, Wiering L, et al. Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: a by-proxy society recommendation consensus approach[J]. Am J Transplant, 2020, 20(7):1826-1836.
99
COVID 19 rapid guideline: renal transplantation[M/OL]. London: National Institute for Health and Care Excellence (NICE). (2020-08-19) [2023-01-30].

URL    
100
Kute VB, Guleria S, Bhalla AK, et al. ISOT consensus statement for the kidney transplant recipient and living donor with a previous diagnosis of COVID-19[J]. Indian J Nephrol, 2022, 32(4):288-290.
101
Kulkarni AV, Parthasarathy K, Kumar P, et al. Early liver transplantation after COVID-19 infection: the first report[J]. Am J Transplant, 2021, 21(6):2279-2284.
102
Gut G, Góral A, Dal Canton Z, et al. Kidney transplantation in COVID pandemic-a review of guidelines[J]. J Clin Med, 2021, 10(13):2877.
103
Mahajan S, Kohli HS, Gupta KL, et al; COVID-19 Working Group of Indian Society of Nephrology. Infection prevention and control guidelines for COVID[J]. Indian J Nephrol, 2020, 30(3):185-187.
104
Biancone L, Minetti E, De Rosa P, et al. Telemedicine monitoring in the follow-up of kidney transplant recipients: consensus indications from an Italian panel of surgeons and nephrologists after the COVID-19 experience[J]. J Nephrol, 2022, 35(3):725-733.
105
Sever MS, Vanholder R, Oniscu G, et al. Kidney transplantation during mass disasters - from COVID-19 to other catastrophes: a consensus statement by the DESCARTES Working Group and Ethics Committee of the ERA[J]. Nephrol Dial Transplant, 2022:gfac251.
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