Epidemiološka i klinička očitovanja pandemije i infekcije COVID -19 na program i ishode transplantacije jetre

master's thesis

• Title (english): Epidemiological and clinical manifestations of COVID-19 pandemic and infection on liver transplant program and outcomes
• Author: Maja Perica
• Mentor: Anna Mrzljak (mentor)
• Committee member: Tatjana Vilibić Čavlek (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Anna Mrzljak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

COVID-19, bolest koju uzrokuje SARS-CoV-2 pojavila se prvi puta u prosincu 2019. godine u kineskom gradu Wuhanu, brzo se proširila cijelim svijetom te je 11. ožujka 2020. godine Svjetska zdravstvena organizacija proglasila pandemiju. Iako je COVID-19 primarno respiratorna bolest, ona može zahvaćati i druge organe, poput jetre. Oštećenje jetre najčešće se manifestira asimptomatskim porastom transaminaza, no u pacijenta s kroničnim jetrenim bolestima može doći do pogoršanja i dekompenzacije bolesti te potrebe za transplantacijom. Osobe s kroničnim jetrenim bolestima i osobe s jetrenim presatkom pod povećanim su rizikom za razvoj teške kliničke slike COVID-19. Imunosupresivna terapija u transplantiranih pacijenata može biti razlog povećanog rizika za razvoj teške kliničke slike bolesti COVID-19, no može imati i protektivni učinak, ovisno o vrsti imunosupresivne terapije. U transplantiranih pacijenata oboljelih od COVID-19 česte su interakcije imunosupresivnih lijekova s lijekovima za terapiju COVID-19, te je stoga potrebno prilagoditi vrstu i dozu imunosupresivne terapije. Pandemija COVID-19 imala je značajan učinak na program transplantacije jetre, koji je bio vidljiv iz smanjenog broja pacijenata uvrštenih na transplantacijsku listu, smanjenog broja dostupnih donora te konačno, smanjenog broja provedenih transplantacija. U područjima u kojima je na početku pandemije incidencija COVID-19 bila veća, transplantacijski program bio je značajnije pogođen nego u područjima u kojima se incidencija COVID-19 povećala nešto kasnije. Učinak pandemije najviše se osjetio u ožujku i travnju 2020. godine, no transplantacijski program se ubrzo nakon toga počeo oporavljati, što govori u prilog dobroj prilagodbi transplantacijskog sustava na uvjete pandemije. Danas već postoje i primjeri uspješno provedenih transplantacija u pacijenata oboljelih od COVID-19.

Abstract (english)

COVID-19, a disease caused by the SARS-CoV-2, first appeared in December 2019 in the Chinese city of Wuhan, spread rapidly around the world, and the World Health Organization declared a pandemic on March 11th 2020. Although COVID-19 is primarily a respiratory disease, it can also affect other organs, such as the liver. While the liver injury is mostly manifested by an asymptomatic transaminitis, in patients with chronic liver disease it can also cause exacerbation and decompensation of the disease which may result in the need for liver transplantation. Patients with chronic liver disease and patients with a liver transplant are at increased risk of developing severe COVID-19. Immunosuppressive therapy in transplant patients may increase the risk of developing severe COVID-19, but may also have a protective effect, depending on the type of immunosuppressive therapy. Interactions of immunosuppressive drugs with drugs used in COVID-19 are common in transplant patients with COVID-19 and therefore, the type and dose of immunosuppressive drugs should be adjusted. The COVID-19 pandemic had a significant impact on the liver transplant program, which was evident from the reduced number of patients included in the transplant list, the reduced number of available donors, and finally, the reduced number of transplants performed. In areas where the incidence of COVID-19 was higher at the beginning of the pandemic, the transplant program was more significantly affected than in areas where the incidence of COVID-19 increased somewhat later. The impact of the pandemic was most obvious in March and April 2020, after which the program began to recover, which shows successful adaptation of the transplant system to pandemic conditions. Today, there are already examples of successfully performed transplants in patients with COVID-19.

• Keywords: COVID-19; transplantacija jetre; transplantacijski program
• Keywords (english): COVID-19; liver transplantation; transplant program
• Language: croatian
• URN:NBN: urn:nbn:hr:105:036014
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-24 13:32:21