移植肾新冠肺炎并发100%肺损伤的成功治疗1例

R. Nuriakhmetov, V. Panteleev, A. R. Zagitov, M. A. Nartailakov, M. Kornilov, I. I. Biganyakov
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引用次数: 0

摘要

背景新型严重急性呼吸系统综合征冠状病毒2型冠状病毒感染研究不足;尽管它在世界范围内流行,但器官移植受者的病例报告很少。目标一例严重急性呼吸系统综合征冠状病毒2型双侧肺炎导致100%肺实质损伤的移植尸体肾患者的动力学评估和治疗效果改善。材料和方法。我们描述了一例移植肾脏患者感染新型冠状病毒(新冠肺炎)的成功治疗病例(2020年12月3日)。新冠肺炎肺炎在移植后早期第7天被诊断。第14天,患者被送入感染病房,病情加重后转入重症监护室。尽管正在进行治疗,但在20年12月24日的CT扫描中,肺实质病变达到100%。患者于2021年1月11日被转移到3号外科接受进一步治疗,因为其临床症状有所改善,实验室动态呈阳性,严重急性呼吸系统综合征冠状病毒2型涂片PCR检测呈阴性。患者于第10天出院接受门诊治疗。结果与讨论。4个月后,对照组胸部CT未发现局灶性浸润性肺部变化。出院后5个月内,观察到总体健康状况改善,血氧饱和度98%,无水肿,移植肾功能满意。结论肾移植后患者由于固有的慢性免疫抑制而特别容易感染。肾移植患者新冠肺炎结果良好的病例证明了及时治疗的有效性。
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Successful Treatment of Transplanted Kidney Patient with 100% Lung Damage Caused by COVID-19 Bilateral Pneumonia: a Clinical Case
Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment. 
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