新冠疫情下的移植病人照護

Solid Organ Transplantation Care in COVID-19 Pandemic Era

2019年起SARS-CoV-2病毒在全球擴散造成新冠肺炎（COVID-19）大流行。新冠肺炎在一般人身上造成的症狀從輕微到嚴重，包括住院、需氧氣治療、死亡，都可能出現。最近的研究顯示，新冠病毒感染會造成移植病人比較嚴重的症狀，而且死亡率比一般人高。新冠病毒對移植醫學的影響既深且廣，幾乎整個移植體系都無可避免。影響的程度則和各國疫情的嚴重度及採用的醫療政策有關。精確的說，包括等待移植的病人、器官移植病人及活體器官捐贈者通通受到影響。一般而言，非危急的移植手術及活體器官捐贈在大流行期間都建議暫停，以避免病人在開刀前後受到新冠病毒的感染。除此之外，在不同的階段，用來控制排斥作用的免疫抑制劑，對新冠肺炎有不同的影響。在感染初期，免疫抑制劑藉由抑制抗體產生及T細胞作用，會增強新冠病毒繁殖速度及下呼吸道病毒數量，但是在感染後期經由控制發炎反應，可以減少細胞激素風暴產生。除了疫苗，個人防護裝備、隔離及單株抗體都被陸續證明可以有效的控制新冠肺炎擴散。一旦感染新冠肺炎，依症狀嚴重度，有些病人可以門診治療，另外有些病人則必須住院接受抗病毒治療包括，瑞德西韋、莫拉皮拉韋、低劑量類固醇及血清球蛋白。最近的研究報告顯示，在Omicron病毒期間，使用抗病毒藥物在門診治療的效果很好。在全面接種疫苗及病毒篩檢配合下，移植手術可以嘗試逐步重新恢復。總結來說，新冠肺炎對移植體系的影響是全面的，但是隨著疫苗的發展及抗病毒藥物的廣泛使用，移植體系是可以小心的逐漸恢復移植治療。

The spreading of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to pandemics of coronavirus disease 2019 (COVID-19). While the symptoms of COVID-19 in general population varies from mild to severe, severe disease is characterized by hospitalization, oxygen supply with ventilation support and mortality. It has been shown that the symptoms of COVID-19 in solid organ transplant recipients are generally more severe with higher mortality rate. The impacts of COVID-19 on solid organ transplant are broad and involve the whole transplant program. The severity was depending on the local COVID-19 incidence rate and policies. Specifically, transplant candidates in the waiting list, recipients and living related donors are all affected. It is also advised that non-critical transplantation and donation should be deferred to avoid peri-operative mortality during pandemics era. The immunosuppressive agents prescribed to control transplant organ rejection have different immunological effects on COVID-19 viral infection. In the initial phase of infection, by suppressing humoral and T cells activities, the immunosuppressants could enhance viral replications and increase lower respiratory tract viral colonies, while in the later phase of infection, immunosuppressants could help to counteract over-whelm inflammatory responses, thus avoid cytokines storms. The mandate of vaccination is suggested by most of the nation. Besides, personal protection equipment (PPE), isolation and monoclonal antibodies against spike protein all have been proved effectively in lowering incidence of COVID-19 infection. Once infected, depending on the severity of symptoms, patients might have to be hospitalized and receive antiviral therapies including remdesivir, molnupiravir, low dose dexamethasone and recovered patient immunoglobulin. Recent data showed that in Omicron era, solid organ transplant recipients contracted COVID-19 could be treated on outpatient clinic and still had favorable survival outcome when compared to patients without antiviral therapies. It has also been illustrated that with the mandate of vaccination and proper nucleic acid screening, transplant program could be restored gradually. In conclusion, the influence of COVID-19 pandemics to the transplant program is widespread. However, with vaccination and development of antiviral therapies, transplant activities could be resumed with careful approaches.