Análise dos impactos da COVID-19 no transplante hepático/Analysis of the impact of COVID-19 on liver transplantation

Natalia Brito Feu, Júlia Antunes Rizzo Bicalho, Eliane Ribas Tameirão da Silva, Matheus Dias Caprini, Mariana Poltronieri Pacheco

Abstract


Introdução: O transplante hepático e? o tratamento de escolha para pacientes com algumas hepatopatias. Apesar da imunossupressão a que são submetidos os receptores de órgãos so?lidos representar importante fator de risco para infecções de etiologia viral, a COVID-19 apresentou evolução discrepante nestes pacientes. A pandemia causada pelo novo coronavírus teve grande impacto nos transplantes de o?rga?os so?lidos de modo global, e na?o se restringiu apenas a aspectos de doadores ou destinata?rios, mas tambe?m a? disponibilidade de recursos da sau?de, uma vez que os sistemas encontraram-se saturados para manejo dos pacientes com COVID-19. Objetivo: Avaliar, de forma narrativa, os principais impactos da pandemia da COVID-19 sobre os transplantes hepa?ticos, a ni?vel nacional e global, discutindo desde o atual cena?rio dos transplantes de fi?gado ate? o quadro cli?nico e manejo dos pacientes transplantados infectados pelo SARS-CoV-2. Métodos: Estudo na?o experimental, descritivo, do tipo revisa?o bibliogra?fica narrativa. Discussão: Observou-se reduc?o?es dra?sticas dos transplantes de doadores cadave?ricos na Franc?a e nos Estados Unidos, correspondendo a 90,6% e 51,1% respectivamente. O Brasil teve redução de 7,9%. O quadro cli?nico da COVID-19 em pacientes po?s-transplante hepático ocorre de modo semelhante a? populac?a?o geral. No que diz respeito ao i?ndice de mortalidade, a taxa entre os transplantados ficou em torno de 4,8%, dado que corresponde ao i?ndice observado na populac?a?o em geral. Supõe-se que a gravidade da COVID-19 está associada a um estado hiper inflamato?rio, e portanto, a terapia imunossupressora poderia apresentar benefi?cios na evolução do quadro. No que diz respeito ao manejo desses pacientes, o principal desafio encontrado e? a manutenc?a?o dos imunossupressores, que devem ser mantida em casos leves e possivelmente reduzidos a partir de casos moderados. As recomendac?o?es das Sociedades de Transplantes e dos guidelines sugerem que ha? seguranc?a na realizac?a?o do transplante hepa?tico durante a pandemia da COVID-19, sendo discutidos riscos e benefícios em cada equipe. Conclusão: Conclui-se que as informações ainda se mostram insuficientes e ha? necessidade de mais estudos a respeito do tema para direcionar de forma mais efetiva as decisões relacionadas ao risco-benefi?cio da realizac?a?o do transplante hepa?tico diante do atual cena?rio e padronizar o manejo adequado desses pacientes.


Keywords


Transplante hepático, COVID-19, Imunossupressores, Revisão bibliográfica.

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DOI: https://doi.org/10.34119/bjhrv3n6-140

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