How Kidney Transplant Patients Cope With Covid-19 Infection
Jan 10, 2023
Patients who have undergone organ transplants are the key protection objects against Covid-19 infection. For this special group, how to deal with Covid-19 infection?
1. After the transplantation, the kidney function has returned to normal, so why are they still at high risk of Covid-19?
Kidney transplant patients, after suffering from Covid-19, have significantly higher severe illness and mortality than the general population. Some people may wonder, after the transplantation, the kidney function recovered very well, shouldn’t it be the same as that of ordinary people? Why is it still a high risk?
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This is because:
1) To avoid organ rejection, patients with kidney transplantation need to take immunosuppressants such as prednisone, mycophenolate mofetil, tacrolimus, etc. for life after surgery, especially the immunosuppressants used within six months after surgery In particularly high doses, these drugs can severely weaken the ability of the own immune system to fight the virus;
2) Some transplant patients also have other health problems such as high blood pressure and diabetes;
3) Low response to vaccines in transplant patients, which would result in vaccines being less effective in protecting transplant patients from severe disease than the general population.
Combining these factors, transplant patients need to be very energetic in the fight against the Covid-19 virus.
In 2022, the medical journal Transplantation published a retrospective study of Omicron infection in kidney transplant patients in Spain:
Among the 117 kidney transplant patients infected with Omicron, 19 patients developed viral pneumonia, 3 patients were admitted to the ICU for treatment, and a total of 4 patients died in the end, with a mortality rate of 3.3%. From this, we can see that the incidence of pneumonia and death rate of kidney transplant patients after infection with Omicron are still at a relatively high level, which is much higher than that of ordinary people.
2. Under what circumstances should pneumonia be suspected?
The common symptoms of kidney transplant patients infected with the Covid-19 virus are still mainly fever and cough. Some patients also have symptoms such as fatigue, headache, muscle aches, diarrhea and abdominal pain, nausea and vomiting, loss of appetite, and loss of sense of smell or taste. Kidney transplant patients who have the above symptoms need to be tested for Covid-19 antigen or nucleic acid in time to confirm the diagnosis.
If dyspnea, shortness of breath, chest discomfort, and chest tightness occur, they indicate the occurrence or progress of lung involvement, and you should go to the hospital in time for blood tests, chest CT and other examinations.
3. Stay at home after infection, or seek medical treatment immediately?
Kidney transplant patients should not take it lightly after being infected with Covid-19, and should not take it for granted that this is just a "small cold". It is recommended that all kidney transplant patients choose to seek medical treatment immediately after being infected with Covid-19.
If it is difficult to seek medical treatment due to some internal or external factors, and you have to choose home monitoring, then these kidney transplant patients need to carefully read the following precautions:
1) What needs to be prepared for home monitoring of kidney transplant patients: thermometer, sphygmomanometer, if possible, it is best to prepare a medical finger-clip blood oxygen saturation detector.
2) When monitoring at home, it is necessary to closely observe the physical condition: if there is a high fever that lasts for 2 days without a downward trend; 93%); lip cyanosis, chest tightness, and chest pain, mental changes, hypotension, significantly decreased urine output or anuria, any of the above should seek medical treatment in time.
4. The antipyretic drugs acetaminophen and ibuprofen are said to be used with caution or forbidden for kidney disease. Can patients with kidney disease use these drugs when they have a fever?
If the body temperature exceeds 38.5°C or the symptoms of pain are obvious, you can use acetaminophen or ibuprofen (choose one, it is not recommended to alternate), the safety is better, and these two are less toxic than other antipyretic and analgesic drugs Nephrotoxicity has been relatively small. But you must pay attention to the matters of taking the medicine: do not use overdose; take the medicine at intervals of no less than 6 hours; do not use it in combination with other cold medicines with the same effect; and ensure adequate water intake.
5. After being infected with Covid-19, should I continue to take or stop taking kidney transplant drugs?
Kidney transplant patients under home monitoring need to continue to take immunosuppressants regularly, and should not stop or change the dose without authorization. Different patients with transplanted kidney disease have different suggestions on whether to adjust the immunosuppressant regimen due to the different severity of Covid-19 infection.
There are three commonly used drugs for kidney transplant patients, mycophenolic acid (mycophenolate mofetil or mycophenolate sodium), calcineurin inhibitors (tacrolimus or cyclosporine), and hormones. It is necessary to assess the risk of rejection after drug reduction, but also to take into account the severity of Covid-19 virus pneumonia. How find a balance between the three drugs and the overall condition requires experienced doctors for different periods and different situations. Individualized adjustment of immunosuppressant regimen.
6. Whether to use "anti-inflammatory drugs" (antibiotics)?
We know that pneumonia directly caused by the Covid-19 virus is viral pneumonia, and antibiotic treatment is ineffective for it. However, for high-risk patients such as kidney transplants, it is necessary to closely observe whether the patient is complicated with bacterial infection or opportunistic infection (carrier lung disease). bunion pneumonia), the doctor will dynamically observe the patient's blood oxygen saturation, blood routine, procalcitonin, sputum microbial culture, body temperature, chest CT and other indicators to decide whether to use antibiotics.
7. Can kidney transplant patients purchase and use the Covid-19 antiviral drug Naimatevir/ritonavir tablets (Paxlovid) by themselves?
Paxlovid can reduce the risk of severe Covid-19, but kidney transplant patients are not recommended to purchase and take Paxlovid by themselves. The reason is that Paxlovid still has certain cardiovascular-related side effects, and the pros and cons need to be weighed, and when used in combination with tacrolimus or cyclosporine, it will increase the blood concentration of tacrolimus or cyclosporine, increasing the risk of drug poisoning, requires frequent monitoring of tacrolimus or cyclosporine blood levels. Please consult your doctor before taking this medicine.
8. Can kidney transplant patients be vaccinated against Covid-19?
Update, an authoritative evidence-based medical data center, pointed out that all patients who have received organ transplants are eligible for the Covid-19 vaccine unless there are contraindications (such as vaccine allergies). While the immunogenicity and effectiveness of Covid-19 vaccines in solid organ transplant recipients are uncertain, the potential benefits of vaccination likely outweigh this uncertainty.
In a retrospective study of Covid-19 virus infection in organ transplant recipients (liver and kidney transplants) published in Am J Transplant in 2022, among 143 transplant patients infected with Covid-19, the hospitalization rate among vaccinated was 26.4%, lower than the 48.5% of the unvaccinated; the mortality rate of the vaccinated was 1.8%, lower than the 9.1% of the unvaccinated.
From the above studies, we have seen the protective effect of vaccines on organ transplant patients.
9. How do kidney transplant patients choose vaccines?
At present, there are mainly the following types of Covid-19 vaccines in China:
1. Inactivated Covid-19 vaccines (Beijing Bio, Wuhan Bio, Sinovac);
2. Recombinant protein vaccines (Zhifei Bio, Livzon Bio, Chengdu Wesker, Zhejiang Clover, Shenzhou Cell);
3. Adenovirus vector vaccine (KangSino);
4. Influenza virus vector Covid-19 vaccine (Beijing Wantai).
For kidney transplant patients in stable condition, inactivated vaccines or recombinant protein vaccines are recommended, but adenovirus vector vaccines or influenza virus vector vaccines are not recommended for the time being.
10. When should kidney transplant patients be vaccinated?
During the special period when the risk of infection with Covid-19 is very high, it is recommended to revaccinate at least 1 month after transplantation, if T cell depleting drugs (such as anti-thymocyte globulin) or specific B cell Tuximab), the vaccine should be postponed for at least 3 months. If you are a uremic patient who has not yet undergone transplantation, you need to wait at least 2 weeks before undergoing transplantation after vaccination.
for more information:Ali.ma@wecistanche.com
