［Abstract］　Due to long-term use of immunosuppressive drugs, organ transplant recipients are at high risk of serious or critical coronavirus disease 2019(COVID-19), and their incidence rate of severe cases and mortality rate are higher than those of a general population. It is of great significance to explore the research progress in diagnosis and treatment of COVID-19 in organ transplant recipients for improving the rescue level of the patients. Therefore, this paper reviews the epidemiology, clinical characteristics, prevention and treatment measures of COVID-19 in organ transplant recipients.]]> 2023/11/3 19:25:14 LAI Yan-hua, LI Jia-zhi,YANG Jian-rong 9true ［Abstract］　Objective　To explore the clinical characteristics of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant infection in kidney transplant recipients and to analyse the factors influencing coronavirus disease 2019(COVID-19) and the time when the viruses turn negative. Methods　The infection profiles of SARS-CoV-2 Omicron variants in kidney transplant recipients who were followed up in the Center for Kidney Transplantation of the Second People′s Hospital of Shanxi Province from December 2022 to February 2023 were retrospectively analyzed. The questionnaire was filled out by internet-based survey, and the epidemiological investigation was conducted on the infected patients′ age, gender, smoking, comorbidity(complicated with chronic diseases), time after kidney transplantation, the time when the viruses turned negative, SARS-CoV-2 vaccine(referred to as “COVID-19 vaccine”) inoculation, immunosuppression regimen, oral administration of ursodeoxycholic acid and SARS-CoV-2 antibody production. The factors influencing COVID-19 vaccine inoculation and the time when the viruses turned negative were analyzed. Results　Six hundred and twenty-eight kidney transplant recipients participated in the survey questionnaire, including 476 in the infected group and 152 in the non-infected group. In the infected group, the male to female ratio was 1.9∶1, and the clinical symptoms of SARS-CoV-2 Omicron variant infection were generally mild; 75.21% of the COVID-19 infected kidney transplant recipients were complicated with one or more chronic diseases, mainly including hypertension and diabetes. There were 300 and 328 cases in the non-vaccination/partical vaccination group and the complete vaccination/enhanced vaccination group, respectively. 82.59%(166/201) of the patients got infected at the time more than 6 months since their last vaccination; SARS-CoV-2 antibodies were tested after infection in 200 kidney transplant recipients, and the median time from infection to antibody detection was 47 days, and 48.50%(97/200) of the patients were IgG positive or weakly positive; the time when the viruses turned negative was correlated with immunosuppression regimen, and the time(when the viruses turned negative) of the immunosuppression regimen containing mycophenolate(MPA) was longer than that of the regimen containing mizoribine(MZR). There were no significant differences in age, gender, time after kidney transplantation, comorbidity and SARS-CoV-2 vaccine inoculation between the infected group and the non-infected group(P>0.05). The SARS-CoV-2 vaccine inoculation was related to gender and time after kidney transplantation. Conclusion　Kidney transplant recipients are generally susceptible to SARS-CoV-2 Omicron variants at all ages and during different postoperative periods, and the clinical symptoms are generally mild. SARS-CoV-2 IgG antibody is commonly produced after infection. Kidney transplant recipients with immunosuppression regimen containing MZR have a shorter time when the viruses turn negative after infection than those with MPA. Vaccination has a certain protective effect, and the vaccination rate is high in males and kidney transplant recipients with a longer time after kidney transplantation.]]> 2023/11/3 19:25:14 GUO Xiao-hong, LI Ning, WANG Ming-jun, et al. 8true ［Abstract］　Objective　To analyze the clinical characteristics of kidney transplant recipients after infection caused by Omicron variant, and to preliminarily explore the clinical value of inactivated coronavirus disease 2019(COVID-19) vaccine in preventing infection caused by Omicron variant. Methods　The clinical data of 290 kidney transplant recipients who were infected with Omicron variant were collected from the Transplantation Follow-up Center of the People′s Hospital of Guangxi Zhuang Autonomous Region during December 1, 2022 and January 31, 2023, and were retrospectively analyzed. According to the vaccination history of inactivated COVID-19 vaccine, the patients were divided into vaccine group(86 cases) and non-vaccine group(204 cases). The patients′ disease grades were evaluated by World Health Organization(WHO) Clinical Progress Scale scores. The incidence rates of 11 common clinical symptoms, the incidence of pneumonia, the grade of disease and the rate of severe disease were compared between the two groups. Results　There were no significant differences in the incidence rates of no symptoms and clinical symptoms after infection with Omicron variant between the patients in two groups(P>0.05). The most common symptoms were fever, cough and myalgia. The incidence of pneumonia, the grade of disease and the incidence of severe disease in the vaccine group were significantly lower than those in the non-vaccine group(P<0.05). Conclusion　The immune protection effect of inactivated COVID-19 vaccine on kidney transplant recipients is limited after vaccination of more than 6 months, but the inactivated COVID-19 vaccine can still reduce the risk of the disease progression and deterioration of the kidney transplant recipients infected with Omicron variant.]]> 2023/11/3 19:25:14 LI Jia-zhi, LUO Mei-xuan, DENG Rui-hua, et al. 7true ［Abstract］　Objective　To analyse the safety and effectiveness of applying Paxlovid in treatment of coronavirus disease 2019(COVID-19) in renal transplant recipients. Methods　The clinical data of allograft renal transplant recipients diagnosed with COVID-19 in the Department of Kidney Transplantation of Beijing Tsinghua Changgung Hospital(BTCH) Affiliated to Tsinghua University from December 2022 to February 2023 were retrospectively analyzed. Among them, 16 renal transplant recipients received treatment of Paxlovid(Paxlovid group) and the other 54 renal transplant recipients did not receive the treatment of Paxlovid(conventional treatment group). The outcomes of the COVID-19 patients, serum creatinine(Scr) and urine protein levels before and after infection, and the interaction between tacrolimus and Paxlovid were analyzed. Results　A definite diagnosis of COVID-19 was made in all the patients and their symptoms improved gradually after starting treatment, with no relapse and dead cases. The level of Scr in the Paxlovid group on the 7th day after infection was significantly higher than that in the conventional treatment group. However, there were no significant differences in the levels of Scr on the 14th day and the 30th day after infection(P>0.05). There were no significant differences in the proportional values of proteinuria between the Paxlovid group and the conventional treatment group before infection, on the 14th day and the 30th day after infection(P>0.05). The proportional values of severe COVID-19 patients in the Paxlovid group and the conventional treatment group were 37.50 %(6/16) and 0.00%(0/54), respectively, with a statistically significant difference(P<0.001). The overall levels of tacrolimus trough concentration in the Paxlovid group were stable. During the oral administration of Paxlovid while withdrawing tacrolimus, the blood concentration of tacrolimus remained above 10 ng/ml in 2 patients, and above 20 ng/ml in the 2 patients who resumed oral tacrolimus. Conclusion　The administration of Paxlovid in renal transplant recipients after suffering from COVID-19 can effectively prevent the deterioration of patients with severe COVID-19, and is conducive to controlling the increase of Scr caused by COVID-19 in the renal transplant recipients, and helps to alleviate the renal function damage caused by COVID-19, with good safety.]]> 2023/11/3 19:25:14 YE Jun-sheng, LIN Fen-wang, XIE Jun-jie, et al. 6true ［Abstract］　Objective　To analyse the efficacy and safety of azvudine in treating moderate coronavirus disease 2019(COVID-19) in kidney transplant recipients. Methods　The clinical data of 65 cases of kidney transplant recipients with COVID-19 who were diagnosed and treated in Department of Nephrology, the First Affiliated Hospital of Army Medical University of the Chinese People′s Liberation Army from December 2022 to February 2023 were retrospectively analyzed, including 45 cases receiving treatment with azvudine(azvudine group) and 20 cases receiving symptomatic treatment(symptomatic treatment group). The negative conversion time of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) nucleic acid, the total course time of disease after treatment, the symptom improvement rate after 7-10 days of treatment, the computed tomography(CT) improvement rate after 7-10 days of treatment, the conversion rate of critical illness and the incidence of drug complications in the two groups were analyzed. Results　In the azvudine group, the negative conversion time of SARS-CoV-2 nucleic acid was (12.98±5.77)days; the total course time of disease after treatment was (14.80±6.35)days; the symptom improvement rate after 7-10 days of treatment was 93.33%; the CT improvement rate after 7-10 days of treatment was 80.00%; the conversion rate of critical illness was 11.11% and the incidence of drug complications was 17.78%, and all the complications were improved after discontinuation of azvudine. In the symptomatic treatment group, the negative conversion time of SARS-CoV-2 nucleic acid was (18.85±8.44)days; the total course time of disease after treatment was (20.00±9.82)days; the symptom improvement rate was 70.00% after 7-10 days of treatment; the CT improvement rate after 7-10 days of treatment was 60.00% and the conversion rate of critical illness was 25.00%. The negative conversion time of SARS-CoV-2 nucleic acid, the total course time of disease and the symptom improvement rate after treatment in the azvudine group were better than those in the symptomatic treatment group, and the differences were statistically significant(P<0.05). Conclusion　Azvudine is effective and safe in treating moderate COVID-19 in kidney transplant recipients. The dosage should be adjusted appropriately to prevent liver function damage.]]> 2023/11/3 19:25:14 YANG Meng, ZHAO Hong-wen, XU Ze-liang, et al. 5true ［Abstract］　Objective　To analyse the clinical manifestations and prognosis of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant infection in populations after liver transplantation. Methods　A telephone survey was conducted to investigate the hospitalization rates of the liver transplant population and the compensated chronic liver disease population(a total of 416 patients) infected with Omicron variant. A retrospective analysis of the clinical data of 35 hospitalized patients with positive SARS-CoV-2(six patients underwent liver transplantation and 29 patients underwent non-liver transplantation during the same period) who were admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and the Second Affiliated Hospital of Naval Medical University during the epidemic period of SARS-CoV-2 Omicron variant infection from December 2022 to February 2023 was carried out, and the clinical manifestations and prognosis of the patients were compared. Results　The incidence rates of hospitalization due to Omicron variant infection in the liver transplant population and the compensated chronic liver disease population were 5.57%(16/287) and 4.65%(6/129), respectively, with no statistically significant difference between the two populations(P>0.05). There were no statistically significant differences in age and major clinical symptoms such as fever and cough, clinical classification, pneumonia computed tomography(CT) scores, length of hospitalization, and nucleic acid negative conversion time between the liver transplantation group and the non-liver transplantation group(P>0.05), and there was also no statistically significant difference in the proportion of the patients with hospitalization time ≥2 weeks and poor prognosis(receiving invasive ventilator support or death) between the two groups(P>0.05). Conclusion　The status after liver transplantation does not significantly affect the clinical manifestations, treatments, and outcomes of patients with Omicron variant infection. The significance of liver transplantation history in the prognosis assessment of Omicron variant infection is limited, and further large-scale studies are needed.]]> 2023/11/3 19:25:14 ZHAN Jun-jie, ZHANG Lei, HANG Xiao-feng, et al. 4true ［Abstract］　Objective　To explore the effect of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant infection on the early recovery of children undergoing living donor liver transplantation. Methods　The case data of pediatric liver transplantation completed by Department of Pediatric Organ Transplantation, Organ Transplantation Center, Tianjin First Central Hospital from December 2022 to February 2023 were retrospectively analyzed. According to the results of COVID-19 nucleic acid tests within 1 month before operation, the pediatric patients were divided into positive group(8 cases) and negative group(11 cases). The baseline data, early postoperative blood routine, liver function and blood concentration of tacrolimus(Tac, or FK506) were analyzed between the two groups. Results　There were no significant differences in gender, age, body weight, and pediatric end-stage liver disease(PELD) scores between the positive group and the negative group(P>0.05). There were no significant differences in graft weight, graft to recipient weight ratio(GRWR), cold ischemia time, anhepatic phase, as well as postoperative ventilator support time, intensive care unit(ICU) hospitalization time, and postoperative hospitalization time between the two groups(P>0.05). There were no significant differences in the trends of changes in blood routine and liver function between the two groups within 2 weeks after operation(P>0.05). No COVID-19 occurred in the recipients of both groups after operation, and there were no statistically significant differences in respiratory symptoms, acute rejection and blood concentration of FK506 between the two groups(P>0.05). Conclusion　SARS-CoV-2 Omicron variant mild infection has no significant effect on the early recovery of children undergoing living donor liver transplantation.]]> 2023/11/3 19:25:14 YANG Yang, DONG Chong, GAO Wei 3true ［Abstract］　Objective　To summarize the experience in diagnosis and treatment of coronavirus disease 2019(COVID-19) patients after liver transplantation. Methods　The clinical data of 8 cases of COVID-19 after liver transplantation who were diagnosed and treated in the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University from December 2022 to January 2023 were retrospectively analyzed and discussed in combination with the literature. Results　Among the 8 cases of COVID-19 after liver transplantation, there were 3 cases of moderate type, 5 cases of severe type, and no cases of critical type. All the patients were cured and discharged from the hospital. The hospital stay was 5-21 days. One patient had persistent low fever and no significant improvement in oxygenation after discharge, and after re-admission to the hospital, the patient recovered and was discharged. There were no cases of progression from moderate/severe type to severe/critical type. Conclusion　The patients are susceptible to COVID-19 after receiving liver transplantation, and there are high risk factors for progression to severe or critical cases. Scientific and reasonable diagnosis and treatment can achieve satisfactory results.]]> 2023/11/3 19:25:14 ZHANG Long, RAO Jian-hua, LYU Ling 2true ［Abstract］　Objective　To analyze the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection and prognosis in liver transplant recipients. Methods　The differences in infection, prognosis and symptoms of post-acute sequelae of SARS-CoV-2 infection among the liver transplant recipients infected with SARS-CoV-2(9 cases), the liver transplant recipients uninfected with SARS-CoV-2(10 cases) and the non-liver transplant recipients infected with SARS-CoV-2(19 cases) were retrospectively analyzed, and the effects of treatment methods on the patients′ prognosis were analyzed. Results　Compared with that in the patients in the other groups, hepatic insufficiency in the liver transplant recipients infected with SARS-CoV-2 was more severe, and the level of immune response in the liver transplant recipients infected with SARS-CoV-2 was lower and the clinical symptoms of post-acute sequelae of SARS-CoV-2 infection were more significant, and the differences were statistically significant(P<0.05). The liver transplant recipients receiving vaccinations, antiviral drugs and prone ventilation had better liver function prognosis, and the differences were statistically significant(P<0.05). Conclusion　After liver transplant recipients are infected with SARS-CoV-2, their hepatic insufficiency is more severe, and the levels of their immune responses are lower, and there are still significant clinical symptoms in the post-acute sequelae of SARS-CoV-2 infection. Vaccination, using antiviral drugs and prone ventilation can help to improve the prognosis.]]> 2023/11/3 19:25:14 QIU Jian, HUANG Fan, WANG Guo-bin, et al. 1true