Expert guidance on prophylaxis strategies and health management of organ transplant recipients infected with COVID-19 in China (first edition)

doi:10.3877/cma.j.issn.1674-3903.2023.01.001

Abstract

Key words: COVID-19, Solid organ transplant recipient, Vaccine, Prophylaxis, Health management

Committee of Health Management for Organ Transplant Recipient, China Organ Transplantation Development Foundation. Expert guidance on prophylaxis strategies and health management of organ transplant recipients infected with COVID-19 in China (first edition)[J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(01): 1-12.

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References 64

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药物种类	禁止联用	建议停用	可以联用
降脂药	辛伐他汀	阿托伐他汀、瑞舒伐他汀	依折麦布、非诺贝特、匹伐他汀、普伐他汀
降压药	乐卡地平	特拉唑嗪、地尔硫卓、氨氯地平、硝苯地平、缬沙坦	β受体阻滞剂、其他ACEI/ARB、呋塞米、氢氯噻嗪
降糖药	－	格列本脲	二甲双胍、胰岛素、达格列净、恩格列净、吡格列酮
抗凝/抗血小板药	替格瑞洛、氯吡格雷、利伐沙班	华法林、艾多沙班	肝素、依诺肝素、阿司匹林、双嘧达莫
镇静催眠药	地西泮、艾司唑仑	唑吡坦、佐匹克隆	劳拉西泮
镇痛药	－	曲马多、羟考酮、吗啡、芬太尼	双氯芬酸、布洛芬、对乙酰氨基酚、塞来昔布、丁丙诺啡、可待因
支气管扩张药	沙美特罗	－	氨茶碱、异丙托溴铵、沙丁胺醇、噻托溴铵、福莫特罗、孟鲁司特
镇咳/化痰药	－	－	右美沙芬、愈创甘油醚、麻黄碱、伪麻黄碱、乙酰半胱氨酸
胃肠道用药	多潘立酮	洛哌丁胺	奥美拉唑、泮托拉唑、法莫替丁、甲氧氯普胺
抗感染药	利福平、利福喷丁	伏立康唑、泊沙康唑	阿奇霉素、西多福韦
精神类药物	－	－	阿米替林、西酞普兰、氟西汀、加巴喷丁、奥氮平、舍曲林
其他	秋水仙碱、胺碘酮	地高辛、坦索罗辛	非那雄胺、左甲状腺素钠

药物种类	禁止联用	建议停用	可以联用
降脂药	辛伐他汀	阿托伐他汀、瑞舒伐他汀	依折麦布、非诺贝特、匹伐他汀、普伐他汀
降压药	乐卡地平	特拉唑嗪、地尔硫卓、氨氯地平、硝苯地平、缬沙坦	β受体阻滞剂、其他ACEI/ARB、呋塞米、氢氯噻嗪
降糖药	－	格列本脲	二甲双胍、胰岛素、达格列净、恩格列净、吡格列酮
抗凝/抗血小板药	替格瑞洛、氯吡格雷、利伐沙班	华法林、艾多沙班	肝素、依诺肝素、阿司匹林、双嘧达莫
镇静催眠药	地西泮、艾司唑仑	唑吡坦、佐匹克隆	劳拉西泮
镇痛药	－	曲马多、羟考酮、吗啡、芬太尼	双氯芬酸、布洛芬、对乙酰氨基酚、塞来昔布、丁丙诺啡、可待因
支气管扩张药	沙美特罗	－	氨茶碱、异丙托溴铵、沙丁胺醇、噻托溴铵、福莫特罗、孟鲁司特
镇咳/化痰药	－	－	右美沙芬、愈创甘油醚、麻黄碱、伪麻黄碱、乙酰半胱氨酸
胃肠道用药	多潘立酮	洛哌丁胺	奥美拉唑、泮托拉唑、法莫替丁、甲氧氯普胺
抗感染药	利福平、利福喷丁	伏立康唑、泊沙康唑	阿奇霉素、西多福韦
精神类药物	－	－	阿米替林、西酞普兰、氟西汀、加巴喷丁、奥氮平、舍曲林
其他	秋水仙碱、胺碘酮	地高辛、坦索罗辛	非那雄胺、左甲状腺素钠

COVID-19临床分型	免疫抑制方案
轻型	(1)移植物功能稳定，免疫抑制方案暂不调整，密切关注病情； (2)根据移植物功能、免疫抑制剂血药浓度、血白细胞下降和细胞免疫状态，调整免疫抑制方案，停用抗增殖类药物，密切关注病情； (3)口服Paxlovid等影响CNI血药浓度的药物前，停用CNI，予适量糖皮质激素替代治疗。注意监测免疫抑制剂血药浓度(包括哺乳动物雷帕霉素靶蛋白抑制剂)、移植物功能和细胞免疫状态。停用Paxlovid后，逐渐恢复CNI用药，起始剂量25%～75%，密切监测血药浓度，以及时作出调整。
中型	(1)根据移植物功能以及细胞和体液免疫监测情况，适时调整免疫抑制强度，停用抗增殖类药物，密切关注移植物功能和病情变化； (2)口服Paxlovid等影响CNI血药浓度的药物前，停用CNI，监测移植物功能、免疫抑制剂血药浓度和机体免疫功能，予小剂量糖皮质激素(地塞米松磷酸钠或甲泼尼龙等)替代治疗。停用Paxlovid后，逐渐恢复CNI用药，起始剂量25%～75%，密切监测血药浓度，以及时作出调整。
重型	(1)推荐大剂量免疫球蛋白(连用3～7 d)，停用所有口服免疫抑制剂，病情好转后参照"中型"免疫抑制方案执行； (2)必要时短期(3～5 d)适量增加糖皮质激素用量，停用所有口服免疫抑制剂，病情好转后参照"中型"免疫抑制方案执行。
危重型	参照"重型"免疫抑制方案，病情好转后参照"中型"免疫抑制方案执行。

COVID-19临床分型	免疫抑制方案
轻型	(1)移植物功能稳定，免疫抑制方案暂不调整，密切关注病情； (2)根据移植物功能、免疫抑制剂血药浓度、血白细胞下降和细胞免疫状态，调整免疫抑制方案，停用抗增殖类药物，密切关注病情； (3)口服Paxlovid等影响CNI血药浓度的药物前，停用CNI，予适量糖皮质激素替代治疗。注意监测免疫抑制剂血药浓度(包括哺乳动物雷帕霉素靶蛋白抑制剂)、移植物功能和细胞免疫状态。停用Paxlovid后，逐渐恢复CNI用药，起始剂量25%～75%，密切监测血药浓度，以及时作出调整。
中型	(1)根据移植物功能以及细胞和体液免疫监测情况，适时调整免疫抑制强度，停用抗增殖类药物，密切关注移植物功能和病情变化； (2)口服Paxlovid等影响CNI血药浓度的药物前，停用CNI，监测移植物功能、免疫抑制剂血药浓度和机体免疫功能，予小剂量糖皮质激素(地塞米松磷酸钠或甲泼尼龙等)替代治疗。停用Paxlovid后，逐渐恢复CNI用药，起始剂量25%～75%，密切监测血药浓度，以及时作出调整。
重型	(1)推荐大剂量免疫球蛋白(连用3～7 d)，停用所有口服免疫抑制剂，病情好转后参照"中型"免疫抑制方案执行； (2)必要时短期(3～5 d)适量增加糖皮质激素用量，停用所有口服免疫抑制剂，病情好转后参照"中型"免疫抑制方案执行。
危重型	参照"重型"免疫抑制方案，病情好转后参照"中型"免疫抑制方案执行。

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