Title Utjecaj COVID-19 na primatelje i kandidate za transplantaciju jetre Title (english) The effect of COVID-19 on recipients of and candidates for liver transplantation Author Leo Bezdrov Mentor Tajana Filipec Kanižaj (mentor)Committee member Lucija Virović Jukić (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Tajana Filipec Kanižaj (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Bolest COVID-19 je u rekordnom vremenu iz respiratorne viroze prerasla u globalnu pandemiju koja je u svega nekoliko mjeseci paralizirala gotovo svaki aspekt modernoga života. Uzročnik bolesti, SARS-CoV-2, ulazi u ljudske stanice putem ACE2 receptora koji su prisutni na stanicama organa kao što su pluća, tanko i debelo crijevo, srce, štitnjača, ali i jetra. Suprotno očekivanjima, pokazalo se da je ACE2 receptor više prisutan na kolangiocitima nego na hepatocitima. Štoviše, na životinjskim modelima utvrđena je povećana ekspresija ACE2 receptora na kolangiocitima nakon parcijalne hepatektomije što se može izravno povezati s povećanom incidencijom COVID-19 kod pacijenata s presadkom jetre. Oštećenje jetre može nastati izravnim učinkom virusa, pretjeranim imunološkim odgovorom na infekciju, hepatotoksičnošću lijekova, hipoksijskom ozljedom i/ili egzacerbacijom kronične bolesti jetre. Akutna jetrena lezija kod oboljelih od COVID-19 najčešće se očituje kao asimptomatski porast jetrenih enzima. Pacijenti s kroničnom bolesti jetre i pacijenti s transplantiranom jetrom pod povećanim su rizikom od oboljenja od COVID-19 i od razvoja teške kliničke slike, a osobe s dekompenziranom cirozom jetre, alkoholnom bolesti jetre te hepatocelularnim karcinomom imaju povećan rizik smrtnosti od COVID-19. Pokazalo se da imunosupresivni lijekovi stupaju u interakciju s virusnim mehanizmom na različite načine koji mogu biti ili štetni ili protektivni ovisno o vrsti lijeka koji se koristi. Shodno navedenome, opravdano je promijeniti vrstu imunosupresivne terapije u svrhu poboljšanja kliničkog ishoda kod pacijenata s transplantiranom jetrom oboljelih od COVID-19. Nadalje, pokazalo se da smanjenje doze imunosupresivne terapije nema pozitivnog učinka na klinički ishod, te zbog toga nije preporučeno, osim u specifičnim slučajevima. Kvalitetna i pravovremena zdravstvena skrb najznačajniji je čimbenik preživljenja zbog čega su svjetska društva za bolesti jetre izdala preporuke za provođenje programa probira i kontrolnih pregleda u uvjetima pandemije. Također, dostupno je i cijepljenje protiv COVID-19 koje se preporuča svim pacijentima s kroničnom bolesti jetre i pacijentima s transplantiranom jetrom.
Abstract (english) COVID-19 has gone from a respiratory disease to a global pandemic that has paralyzed nearly every facet of the modern world in mere months. SARS-CoV-2 infiltrates human cells via the ACE2 receptor which is expressed in many different organs such as the lungs, the intestines, the heart, the thyroid and the liver. Contrary to expectations, it has been observed that ACE2 receptors are several times more commonly found on cholangiocytes as opposed to hepatocytes. Moreover, tests done on animal models have shown increased ACE2 receptor expression in cholangiocytes following a partial hepatectomy which could be directly associated with the increased incidence of COVID-19 in liver transplant patients. Liver damage may arise as a consequence of direct viral infection, excessive immune response, drug hepatotoxicity, hypoxic tissue injury and/or exacerbation of chronic liver disease. Acute liver damage in COVID-19 patients most commonly manifests as an asymptomatic elevation in liver enzymes. Patients with chronic liver disease and liver transplant patients are at an increased risk of contracting COVID-19 and developing severe COVID while increased mortality risk of COVID-19 has been found in patients with cirrhosis, alcoholic liver disease and hepatocellular carcinoma. It has been observed that immunosuppressants interact with viral replication mechanisms in ways that can be either beneficial or damaging depending on the type of drug used. Therefore, it is justified to change the type of immunosuppressant therapy in order to achieve a more favourable clinical outcome in liver transplant patients. In addition, immunosuppressant dosage reduction does not appear to have a positive clinical effect and is thus not recommended, except under specific circumstances. Timely medical care of high quality is the most impactful factor of survival in these patients which is why the world liver societies have issued recommendations for carrying out screening programmes and check-ups under the restraints of the pandemic. On top of that, anti-COVID vaccines are readily available and vaccination is recommended for all patients with chronic liver disease and liver transplant patients.
Keywords
COVID-19
kronična bolest jetre
transplantacija jetre
Keywords (english)
COVID-19
chronic liver disease
liver transplantation
Language croatian URN:NBN urn:nbn:hr:105:409021 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-03 11:39:30
