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Vinutha M, Sharma UR, Swamy G, Rohini S, Vada S, Janandri S, Haribabu T, Taj N, Gayathri SV, Jyotsna SK, Mudagal MP. COVID-19-related liver injury: Mechanisms, diagnosis, management; its impact on pre-existing conditions, cancer and liver transplant: A comprehensive review. Life Sci 2024; 356:123022. [PMID: 39214285 DOI: 10.1016/j.lfs.2024.123022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
AIMS This review explores the mechanisms, diagnostic approaches, and management strategies for COVID-19-induced liver injury, with a focus on its impact on patients with pre-existing liver conditions, liver cancer, and those undergoing liver transplantation. MATERIALS AND METHODS A comprehensive literature review included studies on clinical manifestations of liver injury due to COVID-19. Key areas examined were direct viral effects, drug-induced liver injury, cytokine storms, and impacts on individuals with chronic liver diseases, liver transplants, and the role of vaccination. Data were collected from clinical trials, observational studies, case reports, and review literature. KEY FINDINGS COVID-19 can cause a spectrum of liver injuries, from mild enzyme elevations to severe hepatic dysfunction. Injury mechanisms include direct viral invasion, immune response alterations, drug toxicity, and hypoxia-reperfusion injury. Patients with chronic liver conditions (such as alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma) face increased risks of severe outcomes. The pandemic has worsened pre-existing liver conditions, disrupted cancer treatments, and complicated liver transplantation. Vaccination remains crucial for reducing severe disease, particularly in chronic liver patients and transplant recipients. Telemedicine has been beneficial in managing patients and reducing cross-infection risks. SIGNIFICANCE This review discusses the importance of improved diagnostic methods and management strategies for liver injury caused by COVID-19. It emphasizes the need for close monitoring and customized treatment for high-risk groups, advocating for future research to explore long-term effects, novel therapies, and evidence-based approaches to improve liver health during and after the pandemic.
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Affiliation(s)
- M Vinutha
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Uday Raj Sharma
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India.
| | - Gurubasvaraja Swamy
- Department of Pharmaceutical Chemistry, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S Rohini
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Surendra Vada
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Suresh Janandri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - T Haribabu
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Nageena Taj
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S V Gayathri
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - S K Jyotsna
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
| | - Manjunatha P Mudagal
- Department of Pharmacology, Acharya & BM Reddy College of Pharmacy, Acharya Dr. Sarvepalli Radhakrishna Road, Achit Nagar (Post), Soldevanahalli, Bengaluru, India
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Islam M, Edwards B, Goddard J, Kuddus RH. Immediate Impact of the COVID-19 Pandemic on Heart and Kidney Transplantation and the Recovery Trends in 30 Developed and Less-Developed Countries. Ann Transplant 2024; 29:e942188. [PMID: 38225813 PMCID: PMC10802079 DOI: 10.12659/aot.942188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic had multifaceted and disproportionate impacts on various countries. We investigated the decline of heart and kidney transplantation in 2020 and recovery trends in 2020, 2021, and 2022 in 30 developed and developing countries, considering COVID-19 incidence and mortality and pandemic-time economic variables. MATERIAL AND METHODS Data were obtained from reliable open databases. Nations were grouped by hierarchical cluster analysis into high-gross domestic product (GDP), mid-GDP, and low-GDP countries. Expected transplant numbers for 2020 to 2021 were estimated by the artificial neural network method using data from 2015 to 2019. Effect size and its inference were determined through the Hodges-Lemann estimate and Wilcoxon signed-rank test, respectively. The possible disproportionate effect was estimated by the Jonckheere-Tersptra test. Associations between transplantation and economic variables, COVID-19 caseload, and mortality were examined using Kendall rank correlation analysis. RESULTS All nations experienced a decline in 2020 and some real recovery in 2020 to 2022. For high-GDP countries, decline was insignificant and recovery was marginal; for mid-GDP countries, decline was significant for heart and deceased kidneys and recovery was modest; for low-GDP countries, decline was significant for heart, live kidneys, and deceased kidneys and recovery was marginal. The low-GDP countries were disproportionally negatively impacted, although the associations between the impact and economic variables, COVID-19 incidence, and COVID-19 mortality were statistically insignificant. CONCLUSIONS More inclusive studies of socioeconomic and cultural factors that affected the impact of the COVID-19 pandemic in different countries can be useful for better preparedness and reducing disruption in healthcare in future global pandemics.
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Affiliation(s)
- Mohammad Islam
- Department of Mathematics, Utah Valley University, Orem, UT, USA
| | - Bryson Edwards
- Department of Biology, Utah Valley University, Orem, UT, USA
| | - Jeffrey Goddard
- Department of Biology, Utah Valley University, Orem, UT, USA
| | - Ruhul H. Kuddus
- Department of Biology, Utah Valley University, Orem, UT, USA
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Kececi Ozgur G, Ozdil A, Korkmaz P, Akcam Tİ. Multiple life-threatening complications in a patient who received lung transplantation due to cystic fibrosis and their management. THERAPEUTIC ADVANCES IN PULMONARY AND CRITICAL CARE MEDICINE 2024; 19:29768675241302903. [PMID: 39651041 PMCID: PMC11622289 DOI: 10.1177/29768675241302903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 11/08/2024] [Indexed: 12/11/2024]
Abstract
Cystic fibrosis patients may be considered for lung transplantation. Although these patients may experience more successful outcomes and survival rates compared to others, various complications can arise. In particular, infectious complications and septic deaths may be more prevalent in cystic fibrosis patients compared to other lung transplant indications. Considering all these factors, recognizing and managing complications that may arise during the postoperative period in this patient group are of critical importance. In this article, multiple life-threatening complications occurring in the post-transplant period in a patient who underwent lung transplantation due to cystic fibrosis are chronologically presented, and their management is discussed.
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Affiliation(s)
| | - Ali Ozdil
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Pervin Korkmaz
- Pulmonary Diseases Clinic, Medicana International Hospital, Istanbul, Turkey
| | - Tevfik İlker Akcam
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
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Kim SH, Wi YM, Moon C, Kang JM, Kim M, Kim J, Kim JM, Seok H, Shi HJ, Lee SJ, Lee JY, Jeong SJ, Choe PG, Huh K, Lee SO, Kim SI, Transplant Infection Research Committee of the Korean Society of Infectious Diseases. Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:145-154. [PMID: 37614183 PMCID: PMC10583974 DOI: 10.4285/kjt.23.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.
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Affiliation(s)
- Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minhwa Kim
- Korea Organ Donation Agency, Seoul, Korea
| | - Jungok Kim
- Division of Infectious Diseases, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Jin Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Yeon Lee
- Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Shi Y, Wang M, Wu L, Li X, Liao Z. COVID-19 associated liver injury: An updated review on the mechanisms and management of risk groups. LIVER RESEARCH 2023; 7:207-215. [PMID: 39958382 PMCID: PMC11792068 DOI: 10.1016/j.livres.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 09/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with various liver injury cases worldwide. To date, the prevalence, mechanism, clinical manifestations, diagnosis, and outcomes of COVID-19-induced liver injury in various at-risk groups are not well defined. Liver injury may arise in the prevention and treatment of COVID-19 from direct causes such as viral infection and indirect causes such as systemic inflammation, hypoxic changes, and drugs that exacerbate any pre-existing liver disease. Studies have found that patients with underlying liver disease are at higher risk of COVID-19-induced liver injury. Certain condition of cardiopulmonary and metabolic diseases and vulnerable stages in lifespan may also involve in the development of COVID-19-induced liver injury. This review summarized studies of COVID-19-induced liver injury in different at-risk groups regarding their clinical characteristics, parameters, and correlations of the severity with these indicators and signs as well as potential treatment suggestions, to increase attention to physiological and pathological conditions and continue liver function monitoring as they can help in strengthening early supportive treatment and reducing the incidence of adverse outcomes.
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Affiliation(s)
- Yue Shi
- Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Mina Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, China
| | - Liqun Wu
- Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
| | - Xuexin Li
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solna, Sweden
| | - Zehuan Liao
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden
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Imam MT, Almalki ZS, Alzahrani AR, Al-Ghamdi SS, Falemban AH, Alanazi IM, Shahzad N, Muhammad Alrooqi M, Jabeen Q, Shahid I. COVID-19 and severity of liver diseases: Possible crosstalk and clinical implications. Int Immunopharmacol 2023; 121:110439. [PMID: 37315370 PMCID: PMC10247890 DOI: 10.1016/j.intimp.2023.110439] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
COVID-19-infected individuals and those who recovered from the infection have been demonstrated to have elevated liver enzymes or abnormal liver biochemistries, particularly with preexisting liver diseases, liver metabolic disorders, viral hepatitis, and other hepatic comorbidities. However, possible crosstalk and intricate interplay between COVID-19 and liver disease severity are still elusive, and the available data are murky and confined. Similarly, the syndemic of other blood-borne infectious diseases, chemical-induced liver injuries, and chronic hepatic diseases continued to take lives while showing signs of worsening due to the COVID-19 crisis. Moreover, the pandemic is not over yet and is transitioning to becoming an epidemic in recent years; hence, monitoring liver function tests (LFTs) and assessing hepatic consequences of COVID-19 in patients with or without liver illnesses would be of paramount interest. This pragmatic review explores the correlations between COVID-19 and liver disease severity based on abnormal liver biochemistries and other possible mechanisms in individuals of all ages from the emergence of the COVID-19 pandemic to the post-pandemic period. The review also alludes to clinical perspectives of such interactions to curb overlapping hepatic diseases in people who recovered from the infection or living with long COVID-19.
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Affiliation(s)
- Mohammad T Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Abdullah R Alzahrani
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia
| | - Saeed S Al-Ghamdi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia
| | - Alaa H Falemban
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia
| | - Ibrahim M Alanazi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia
| | - Naiyer Shahzad
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia
| | | | - Qaisar Jabeen
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Shahid
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, Makkah 21955, Saudi Arabia.
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Hernández D, Caballero A. Kidney transplant in the next decade: Strategies, challenges and vision of the future. Nefrologia 2023; 43:281-292. [PMID: 37635014 DOI: 10.1016/j.nefroe.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/24/2022] [Indexed: 08/29/2023] Open
Abstract
Although the results of kidney transplantation (KT) have improved substantially in recent years, a chronic and inexorable loss of grafts mainly due to the death of the patient and chronic dysfunction of the KT, continues to be observed. The objectives, thus, to optimize this situation in the next decade are fundamentally focused on minimizing the rate of kidney graft loss, improving patient survival, increasing the rate of organ procurement and its distribution, promoting research and training in health professionals and the development of scientific registries providing clinical and reliable information that allow us to optimize our clinical practice in the field of KT. With this perspective, this review will deep into: (1) strategies to avoid chronic dysfunction and graft loss in the medium and long term; (2) to prolong patient survival; (3) strategies to increase the donation, maintenance and allocation of organs; (4) promote clinical and basic research and training activity in KT; and (5) the analysis of the results in KT by optimizing and merging scientific registries.
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Affiliation(s)
- Domingo Hernández
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario Carlos Haya, Instituto Biomédico de Investigación de Málaga (IBIMA), Universidad de Málaga, REDinREN, Málaga, Spain.
| | - Abelardo Caballero
- Sección de Inmunología, Hospital Regional Universitario Carlos Haya, Instituto Biomédico de Investigación de Málaga (IBIMA), Universidad de Málaga, REDinREN, Málaga, Spain
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Versorgung von Lebertransplantierten während der COVID-19-Pandemie. DIE GASTROENTEROLOGIE 2023. [PMCID: PMC9983509 DOI: 10.1007/s11377-023-00675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Hintergrund Die Pandemie durch Coronavirus Disease 2019 (COVID-19) stellt eine anhaltende Herausforderung für das gesamte Gesundheitssystem dar, darunter auch für die Versorgung von Lebertransplantierten, die eine besondere Risikogruppe darstellen. Fragestellung Ziel der Arbeit ist es, einen praxisnahen Überblick über die aktualisierte S1-Leitlinie zur Versorgung von Lebertransplantierten während der COVID-19-Pandemie zu geben. Material und Methoden Basis dieser Übersicht ist die aktualisierte Leitlinie (Stand 15.06.2022) der Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Ergebnisse Während der Pandemie sollen Lebertransplantationsprogramme inklusive Evaluation, Organspenden und Nachsorge möglichst unverändert fortgeführt werden, da sie eine lebensrettende Therapieoption darstellen. Je nach Pandemielage sind jedoch Anpassungen möglich. Die Impfungen gegen „severe acute respiratory syndrome coronavirus type 2“ (SARS-CoV-2) sollen entsprechend den Empfehlungen der Ständigen Impfkommission (STIKO) erfolgen, und Antikörperbestimmungen sind sinnvoll. Im Fall einer Infektion stehen verschiedene Therapieoptionen zur Verfügung. Eine präventive Anpassung der Immunsuppression soll nicht erfolgen, eine Anpassung von Mycophenolat-Mofetil-haltigen Regimen sowie eine Anpassung bei SARS-CoV-2-Infektion kann jedoch sinnvoll sein. Schlussfolgerungen Die mittlerweile zur Verfügung stehende Immunisierung sowie die antivirale/immunmodulierende Therapie erlauben eine deutlich verbesserte Prävention und Therapie von COVID-19 bei Lebertransplantierten. Eine frühzeitige Erkennung durch engmaschige Testung ist von hoher Wichtigkeit. Die verbesserten pharmakologischen Optionen ermöglichen unter Risiko-Nutzen-Abwägung auch eine Transplantation von positiven Spendern oder Empfängern.
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Shimizu S, Sakamoto S, Yamada M, Funaki T, Fukuda A, Uchida H, Okada N, Nakao T, Kodama T, Komine R, Shoji K, Baba C, Suzuki Y, Nakagawa S, Ogimi C, Kasahara M. Successful pediatric liver transplantation case with a positive SARS-CoV-2 test at the time of transplant. Hepatol Res 2023. [PMID: 36654476 DOI: 10.1111/hepr.13881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
AIM We report a successful liver transplantation (LT) in a child with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE PRESENTATION A 3-year-old female patient with decompensated cirrhosis due to Alagille syndrome underwent a split LT with a left lateral segment graft. She had a history of SARS-CoV-2 infection 4 months before LT. She was exposed to SARS-CoV-2 after the decision for organ acceptance. We repeatedly confirmed the negative SARS-CoV-2 test by polymerase chain reaction (PCR) before LT. Liver transplantation was carried out in the negative pressure operational theater with full airborne, droplet, and contact precautions as the patient was considered to be within the incubation period of SARS-CoV-2. The SARS-CoV-2 PCR test became positive in the nasopharyngeal swab specimen at the operation. Remdesivir, the antiviral treatment, was held off due to potential hepatotoxicity and no exacerbation of COVID-19. She received tacrolimus and low-dose steroids per protocol. She remained SARS-CoV-2 positive on postoperative days (PODs) 1, 2, and 5. The presence of antibodies for SARS-CoV-2 at LT was confirmed later. On POD 53, she was discharged without any symptomatic infection. CONCLUSION This case demonstrated that a positive SARS-CoV-2 result was not an absolute contraindication for a life-saving LT. Liver transplantation could be safely performed in a pediatric patient with asymptomatic COVID-19 and S-immunoglobulin G antibodies for SARS-CoV-2.
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Affiliation(s)
- Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masaki Yamada
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan.,Department of Advanced Medicine for Viral Infections, National Center for Child Health and Development, Tokyo, Japan
| | - Takanori Funaki
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Noriki Okada
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshimasa Nakao
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tasuku Kodama
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ryuji Komine
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Baba
- Department of Anesthesia and Intensive Care, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Anesthesia and Intensive Care, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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He J, Liu S, Tan Q, Liu Z, Fu J, Li T, Wei C, Liu X, Mei Z, Cheng J, Wang K, Fu J. Antiviral Potential of Small Molecules Cordycepin, Thymoquinone, and N6, N6-Dimethyladenosine Targeting SARS-CoV-2 Entry Protein ADAM17. Molecules 2022; 27:molecules27249044. [PMID: 36558177 PMCID: PMC9781528 DOI: 10.3390/molecules27249044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is an acute respiratory disease caused by SARS-CoV-2 that has spawned a worldwide pandemic. ADAM17 is a sheddase associated with the modulation of the receptor ACE2 of SARS-CoV-2. Studies have revealed that malignant phenotypes of several cancer types are closely relevant to highly expressed ADAM17. However, ADAM17 regulation in SARS-CoV-2 invasion and its role on small molecules are unclear. Here, we evaluated the ADAM17 inhibitory effects of cordycepin (CD), thymoquinone (TQ), and N6, N6-dimethyladenosine (m62A), on cancer cells and predicted the anti-COVID-19 potential of the three compounds and their underlying signaling pathways by network pharmacology. It was found that CD, TQ, and m62A repressed the ADAM17 expression upon different cancer cells remarkably. Moreover, CD inhibited GFP-positive syncytia formation significantly, suggesting its potential against SARS-CoV-2. Pharmacological analysis by constructing CD-, TQ-, and m62A-based drug-target COVID-19 networks further indicated that ADAM17 is a potential target for anti-COVID-19 therapy with these compounds, and the mechanism might be relevant to viral infection and transmembrane receptors-mediated signal transduction. These findings imply that ADAM17 is of potentially medical significance for cancer patients infected with SARS-CoV-2, which provides potential new targets and insights for developing innovative drugs against COVID-19.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kai Wang
- Correspondence: (J.C.); (K.W.); (J.F.)
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Juric I, Katalinic L, Furic-Cunko V, Basic-Jukic N. Kidney Transplantation in Patients With the History of SARS-CoV-2 Infection. Transplant Proc 2022; 54:2673-2676. [PMID: 36184341 PMCID: PMC9444488 DOI: 10.1016/j.transproceed.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study is to present the experience and results of kidney transplantation in patients with the history of SARS-CoV-2 infection. METHODS We retrospectively analyzed waitlisted patients who had a history of SARS-CoV-2 infection and offered a kidney transplant between March 2020 and December 2021. RESULTS Of the 97 waitlisted potential kidney transplant recipients who were offered a kidney, 13 (13.4%) had a history of SARS-CoV-2 infection. All patients were tested negative for SARS-CoV-2 at the time of the kidney offer. Successful transplantation was performed in 9 patients (5 male; average age was 40.8 years), with the average time between SARS-CoV-2 infection and transplantation of 8 months. Four of 13 patients with a history of SARS-CoV-2 infection were finally not transplanted, with 2 patients not eligible for transplantation due to significant post-COVID findings in routine pretransplant chest CT scans, and 2 patients were not transplanted because of poor donor organ quality. CONCLUSIONS Kidney transplantation after SARS-CoV-2 infection is possible in a setting of full recovery from acute infection, negative PCR test, and no pneumonic infiltrates on chest CT scan. A growing number of waitlisted patients with a history of SARS-CoV-2 infection imposes the need for decision-making tools and guidelines for risk/benefit assessment in these patients.
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Affiliation(s)
- Ivana Juric
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia..
| | - Lea Katalinic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vesna Furic-Cunko
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
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12
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Elghannam MT, Hassanien MH, Ameen YA, ELattar GM, ELRay AA, Turky EA, ELTalkawy MD. COVID-19 and liver diseases. EGYPTIAN LIVER JOURNAL 2022; 12:43. [PMID: 35880136 PMCID: PMC9301896 DOI: 10.1186/s43066-022-00202-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus causes an outbreak of viral pneumonia that spread throughout the world. Liver injury is becoming more widely recognized as a component of the clinical picture of COVID-19 infection. Hepatitis with serum ALT elevation has been reported in up to half of patients. Patients with CLD were at a higher risk of decompensation with liver failure, hospitalization, and mortality. The percentage of acute liver injury (ALI) varied from 5 to 28%. COVID-19 hinders HCV elimination by 2030. It is recommended to continue treatment of chronic HCV and chronic HBV if already receiving treatment. Consider using antiviral therapy to prevent viral flare-ups in patients with occult or resolved HBV and COVID-19 who are receiving immunosuppressive agents. Patients with AIH do not have an increased risk of adverse outcomes even in high-risk areas. There is an association between MAFLD and disease progression. Patients with any type of cancer are at a higher risk of infection and are more likely to develop more severe clinical outcomes. Most societies advise against immunosuppressant modifications in patients with mild COVID-19, whereas in rare cases such as severe lymphopenia, worsening pneumonia, or bacterial or fungal superinfection, reduction or discontinuation of antiproliferative agents and lymphocyte-depleting therapies has been suggested.
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15
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Tacke F, Cornberg M, Sterneck M, Trebicka J, Settmacher U, Bechstein WO, Berg T. S1-Leitlinie zur Versorgung von Lebertransplantierten während der COVID-19-Pandemie – AWMF-Registernummer: 021-031 – Stand 15. Juni 2022. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1678-1698. [PMID: 36368659 DOI: 10.1055/a-1934-1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Charité Mitte/Campus Virchow-Klinikum, 13353 Berlin
| | - Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, 30625 Hannover; Centre for individualised infection Medicine (CiiM), Hannover; Deutsches Zentrum für Infektionsforschung (DZIF)
| | - Martina Sterneck
- Universitätsklinikum Hamburg-Eppendorf, I. Medizinische Klinik und Poliklinik, 20246 Hamburg
| | - Jonel Trebicka
- Universitätsklinikum Münster, Medizinische Klinik B, 48149 Münster
| | - Utz Settmacher
- Universitätsklinikum Jena, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, 07747 Jena
| | - Wolf Otto Bechstein
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, 60590 Frankfurt
| | - Thomas Berg
- Universitätsklinikum Leipzig AöR, Bereich Hepatologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, 04103 Leipzig
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16
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Peghin M, Grossi PA. COVID-19 positive donor for solid organ transplantation. J Hepatol 2022; 77:1198-1204. [PMID: 35798131 PMCID: PMC9251900 DOI: 10.1016/j.jhep.2022.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has significantly changed organ donation and transplantation worldwide. Since the beginning of the pandemic, the uncertainty regarding the potential route of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created tremendous pressures on transplantation communities, and international organisations have advised against using organs from deceased donors who have tested positive for SARS-CoV-2. The possibility of SARS-CoV-2 transmission through organ donation has only been reported for lung transplantation; hence, based on current experience, transplantation of non-lung organs from donors with active SARS-CoV-2 infection has been considered possible and safe, at least over short-term follow-up. As the evolving outbreak of SARS-CoV-2 continues, alongside the presence of vaccines and new treatment options, clinicians should consider transplanting organs from deceased donors with active SARS-CoV-2 infection to recipients with limited opportunities for transplantation and those with specific natural or vaccine-induced immunity. This article proffers an expert opinion on the use of organs from deceased donors with resolved or active SARS-CoV-2 infection in the absence of more definitive data and standardised acceptance patterns.
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Affiliation(s)
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy.
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17
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Woolley AE, Delmonico FL. A Current Approach to Evaluate the Risk of COVID-19 Transmission From an Organ Donor to Increase Organ Utilization. EXP CLIN TRANSPLANT 2022; 20:1-4. [DOI: 10.6002/ect.donorsymp.2022.l10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Kute VB, Guleria S, Bhalla AK, Sharma A, Agarwal SK, Sahay M, Varughese S, Prasad N, Varma PP, Shroff S, Vardhan H, Balwani M, Dave S, Bhadauria D, Rathi M, Agarwal D, Shah P, Prakash J. ISOT Consensus Statement for the Kidney Transplant Recipient and Living Donor with a Previous Diagnosis of COVID-19. Indian J Nephrol 2022; 32:288-290. [PMID: 35967531 PMCID: PMC9365002 DOI: 10.4103/ijn.ijn_120_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Sharma
- Department of Transplantation Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - SK Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - PP Varma
- Department of Nephrology, Primus Super Speciality Hospital, Delhi, New Delhi, India
| | | | - Harsh Vardhan
- Department of Nephrology, Patna Medical College, Patna, Bihar, India
| | - Manish Balwani
- Department of Nephrology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Shruti Dave
- Department of Pathology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Dhamendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Utter Pradesh, India
| | - Manish Rathi
- Department of Nephrology, PostgraduateInstitute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pankaj Shah
- Department of Nephrology Gujarat University of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Jai Prakash
- President, Indian Society of Organ Transplantation, Former Professor and Head Nephology Banaras Hindu University, Varanasi, Utter Pradesh, India
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19
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Free RJ, Annambhotla P, La Hoz RM, Danziger-Isakov L, Jones JM, Wang L, Sankthivel S, Levi ME, Michaels MG, Kuhnert W, Klassen D, Basavaraju SV, Kracalik IT. Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Through Solid Organ Transplantation and Outcomes of Coronavirus Disease 2019 Among Recent Transplant Recipients. Open Forum Infect Dis 2022; 9:ofac221. [PMID: 35873294 PMCID: PMC9297154 DOI: 10.1093/ofid/ofac221] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmissible through lung transplantation, and outcomes among infected organ recipients may be severe. Transmission risk to extrapulmonary organ recipients and recent (within 30 days of transplantation) SARS-CoV-2-infected recipient outcomes are unclear. METHODS During March 2020-March 2021, potential SARS-CoV-2 transmissions through solid organ transplantation were investigated. Assessments included SARS-CoV-2 testing, medical record review, determination of likely transmission route, and recent recipient outcomes. RESULTS During March 2020-March 2021, approximately 42 740 organs were transplanted in the United States. Forty donors, who donated 140 organs to 125 recipients, were investigated. Nine (23%) donors and 25 (20%) recipients were SARS-CoV-2 positive by nucleic acid amplification test (NAAT). Most (22/25 [88%]) SARS-CoV-2-infected recipients had healthcare or community exposures. Nine SARS-CoV-2-infected donors donated 21 organs to 19 recipients. Of these, 3 lung recipients acquired SARS-CoV-2 infections from donors with negative SARS-CoV-2 testing of pretransplant upper respiratory tract specimens but from whom posttransplant lower respiratory tract (LRT) specimens were SARS-CoV-2 positive. Sixteen recipients of extrapulmonary organs from SARS-CoV-2-infected donors had no evidence of posttransplant COVID-19. All-cause mortality within 45 days after transplantation was 6-fold higher among SARS-CoV-2-infected recipients (9/25 [36%]) than those without (6/100 [6%]). CONCLUSIONS Transplant-transmission of SARS-CoV-2 is uncommon. Pretransplant NAAT of lung donor LRT specimens may prevent transmission of SARS-CoV-2 through transplantation. Extrapulmonary organs from SARS-CoV-2-infected donors may be safely usable, although further study is needed. Reducing recent recipient exposures to SARS-CoV-2 should remain a focus of prevention.
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Affiliation(s)
- Rebecca J Free
- Correspondence: Rebecca Free, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30329-4027, USA ()
| | - Pallavi Annambhotla
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Jefferson M Jones
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Wang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Senthil Sankthivel
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marilyn E Levi
- Division of Transplantation, Health Systems Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Wendi Kuhnert
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Klassen
- United Network for Organ Sharing, Richmond, Virginia, USA
| | - Sridhar V Basavaraju
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian T Kracalik
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Yehuda R, Joshua L, Rodrigo V, Ramona NR. Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients. Transplant Proc 2022; 54:1528-1533. [PMID: 35871876 PMCID: PMC9157021 DOI: 10.1016/j.transproceed.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.
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21
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Trasplante renal en la próxima década: estrategias, retos y visión de futuro. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Wishahi M, Kamal NM. Multidisciplinary basic and clinical research of acute kidney injury with COVID-19: Pathophysiology, mechanisms, incidence, management and kidney transplantation. World J Nephrol 2022; 11:105-114. [PMID: 35733654 PMCID: PMC9160708 DOI: 10.5527/wjn.v11.i3.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/04/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI) linked to coronavirus disease 2019 (COVID-19) has been identified in the course of the disease. AKI can be mild or severe and that is dependent on the presence of comorbidities and the severity of COVID-19. Among patients who had been hospitalized with COVID-19, some were admitted to intensive care unit. The etiology of AKI associated with COVID-19 is multifactorial. Prevention of severe AKI is the prime task in patients with COVID-19 that necessitates a battery of measurements and precautions in management. Patients with AKI who have needed dialysis are in an increased risk to develop chronic kidney disease (CKD) or a progression of their existing CKD. Kidney transplantation patients with COVID-19 are in need of special management to adjust the doses of immunosuppression drugs and corticosteroids to guard against graft rejection but not to suppress the immune system to place the patient at risk of developing a COVID-19 infection. Immunosuppression drugs and corticosteroids for patients who have had a kidney transplant has to be adjusted based on laboratory results and is individualized aiming at the protection of the transplanted from rejection.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
| | - Nabawya M Kamal
- Department of Anaesthesia and Surgical Intensive Care, Theodor Bilharz Research Institute, Cairo 12411, Egypt
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23
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Boan P, Marinelli T, Opdam H. Solid Organ Transplantation From Donors With COVID-19 Infection. Transplantation 2022; 106:693-695. [PMID: 35238852 PMCID: PMC8942597 DOI: 10.1097/tp.0000000000004074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Tina Marinelli
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Helen Opdam
- Organ and Tissue Authority, Canberra, ACT, Australia
- Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia
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24
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Immunosuppression and SARS-CoV-2 Infection in Kidney Transplant Recipients. Transplant Direct 2022; 8:e1292. [PMID: 35187216 PMCID: PMC8843373 DOI: 10.1097/txd.0000000000001292] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
Kidney transplant recipients (KTRs) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have an increased risk of mortality compared with the general population and hemodialysis patients. As these patients are immunosuppressed, it might seem obvious to attribute this excess mortality to the impaired immunity induced by immunosuppression. In line with this reasoning is the low immune response, both cellular and humoral, that KTRs mount in response to the anti–SARS-CoV-2 vaccine; however, acute respiratory distress syndrome associated with coronavirus disease 2019 is triggered by a state of inflammation and cytokine release syndrome that lead to pulmonary damage and increased mortality. In that context, immunosuppressive treatment dampening the immune response could, in theory, be potentially beneficial. This review aims at analyzing the current knowledge on the impact of immunosuppressive treatment on mortality in SARS-CoV-2–infected KTRs, the optimal management of immunosuppression in the coronavirus disease 2019 era, and the vaccine response and management in immunosuppressed KTRs.
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25
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Russo FP, Izzy M, Rammohan A, Kirchner VA, Di Maira T, Belli LS, Berg T, Berenguer MC, Polak WG. Global impact of the first wave of COVID-19 on liver transplant centers: A multi-society survey (EASL-ESOT/ELITA-ILTS). J Hepatol 2022; 76:364-370. [PMID: 34653592 PMCID: PMC8511875 DOI: 10.1016/j.jhep.2021.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The global impact of SARS-CoV-2 on liver transplantation (LT) practices across the world is unknown. The goal of this survey was to assess the impact of the pandemic on global LT practices. METHOD A prospective web-based survey (available online from 7th September 2020 to 31st December 2020) was proposed to the active members of the EASL-ESOT/ELITA-ILTS in the Americas (including North, Central, and South America) (R1), Europe (R2), and the rest of the world (R3). The survey comprised 4 parts concerning transplant processes, therapy, living donors, and organ procurement. RESULTS Of the 470 transplant centers reached, 128 answered each part of the survey, 29 centers (23%), 64 centers (50%), and 35 centers (27%) from R1, R2, and R3, respectively. When we compared the practices during the first 6 months of the pandemic in 2020 with those a year earlier in 2019, statistically significant differences were found in the number of patients added to the waiting list (WL), WL mortality, and the number of LTs performed. At the regional level, we found that in R2 the number of LTs was significantly higher in 2019 (p <0.01), while R3 had more patients listed, higher WL mortality, and more LTs performed before the pandemic. Countries severely affected by the pandemic ("hit" countries) had a lower number of WL patients (p = 0.009) and LTs (p = 0.002) during the pandemic. Interestingly, WL mortality was still higher in the "non-hit" countries in 2020 compared to 2019 (p = 0.022). CONCLUSION The first wave of the pandemic differentially impacted LT practices across the world, especially with detrimental effects on the "hit" countries. Modifications to the policies of recipient and donor selection, organ retrieval, and postoperative recipient management were adopted at a regional or national level. LAY SUMMARY The health emergency caused by the coronavirus pandemic has dramatically changed clinical practice during the pandemic. The first wave of the pandemic impacted liver transplantation differently across the world, with particularly detrimental effects on the countries badly hit by the virus. The resilience of the entire transplant network has enabled continued organ donation and transplantation, ultimately improving the lives of patients with end-stage liver disease.
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Affiliation(s)
- Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua Italy.
| | - Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Varvara A Kirchner
- Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Tommaso Di Maira
- Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; ISS La Fe, Valencia, Spain
| | - Luca Saverio Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University, Medical Center, 04103 Leipzig, Germany
| | - Marina Carmen Berenguer
- Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; ISS La Fe, Valencia, Spain
| | - Wojciech Grzegorz Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre, Rotterdam, the Netherlands
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26
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Martin RL, Grant MJ, Kimani S, Midha S, May J, Patell R, Collier E, Furfaro D, Bodine C, Reap L, Shah N, DeLaune J, Brusca S, Olazagasti C, Goyal S, Rubinstein S, Hakim N, Qin S, Browning SL, Sena L, Gilbert J, Davidson M, Lovly CM, Seetharamu N, Rangachari D, Murphy M, Chatwal M, Paschal R, Henry E, Collichio F, Green JR. Forming the Hematology-Oncology Collaborative Videoconferencing (CO-VID) Learning Initiative: Experiential Lessons Learned From a Novel Trainee-Led Multidisciplinary Virtual Learning Platform. JCO Oncol Pract 2022; 18:e36-e46. [PMID: 34242082 PMCID: PMC8758064 DOI: 10.1200/op.20.00960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model. METHODS Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives. RESULTS In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills. CONCLUSION During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives.
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Affiliation(s)
- Richard L. Martin
- Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, TN,Richard L. Martin III, MD, MPH, Meharry Medical College, Nashville General Hospital, Internal Medicine Department Office, Ste 3148, 1005 Dr DB Todd Jr Blvd, TN 37208; e-mail:
| | - Michael J. Grant
- Section of Hematology-Oncology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Stephen Kimani
- Department of Medicine, The University of North Carolina, Chapel Hill, NC
| | - Shonali Midha
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Jori May
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Rushad Patell
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emily Collier
- Section of Hematology-Oncology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Charles Bodine
- Division of Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Leo Reap
- Department of Medicine, Ascension Providence Hospital, Detroit, MI
| | - Nikesh Shah
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Jess DeLaune
- Division of Hematology-Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Samuel Brusca
- National Institutes of Health Clinical Center, Bethesda, MD
| | - Coral Olazagasti
- Division of Hematology-Oncology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, New Hyde Park, NY
| | - Shreya Goyal
- Division of Hematology-Oncology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, New Hyde Park, NY
| | - Samuel Rubinstein
- Division of Hematology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Nausheen Hakim
- Division of Hematology-Oncology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, Long Island, NY
| | - Shuai Qin
- Division of Hematology-Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, IL
| | - Sabrina L. Browning
- Division of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Laura Sena
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jill Gilbert
- Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Mario Davidson
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Christine M. Lovly
- Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Nagashree Seetharamu
- Division of Hematology-Oncology, Donald and Barbara Zucker School of Medicine at Hofstra University, New Hyde Park, NY
| | - Deepa Rangachari
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Martina Murphy
- Division of Hematology-Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Monica Chatwal
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Rita Paschal
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Henry
- Division of Hematology-Oncology, Department of Internal Medicine, Department of Medical Education, Loyola University Medical Center, Maywood, IL
| | - Frances Collichio
- Division of Hematology Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jennifer R. Green
- Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, TN
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Vitale G, Gitto S, Marra F, Morelli MC. From advanced disease to transplantation: an overview of the liver at the time of COVID-19 pandemic. Intern Emerg Med 2022; 17:15-24. [PMID: 34245423 PMCID: PMC8271284 DOI: 10.1007/s11739-021-02801-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023]
Abstract
In 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also known as coronavirus disease 2019 (COVID-19) disrupted global health, causing hundreds of thousands of deaths worldwide. The liver injury appears to be one of the possible systemic manifestations of COVID-19 disease although the mechanisms causing such injury are not entirely clear. At the beginning of the pandemic, patients with chronic diseases, such as liver cirrhosis, or special populations, such as liver transplant recipients, were considered at higher risk of complications and poor clinical outcomes. Thus, the national transplant programmes have been severely hampered by the COVID-19 pandemic. Furthermore, liver transplant patients are potentially more vulnerable to SARS-CoV-2 infection due to immune suppression, ageing, and metabolic or cardiovascular comorbidities. This review analyses the increasing amounts of data collected in recent months concerning liver cirrhosis and liver transplants to understand if this finding is still relevant with respect to COVID-19 manifestations.
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Affiliation(s)
- Giovanni Vitale
- grid.6292.f0000 0004 1757 1758Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento delle insufficienze d’organo e dei trapianti, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Via Albertoni 15, Bologna, Italy
| | - Stefano Gitto
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Marra
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Cristina Morelli
- grid.6292.f0000 0004 1757 1758Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento delle insufficienze d’organo e dei trapianti, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Via Albertoni 15, Bologna, Italy
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28
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Nacif LS, Fernandes MR, Waisberg DR, Pinheiro RS, Rocha-Santos V, Galvão F, Andraus W, Carneiro-D'Albuquerque L. Liver transplant after SARS-CoV-2 infection: A systematic review. Clinics (Sao Paulo) 2022; 77:100042. [PMID: 35870265 PMCID: PMC9040369 DOI: 10.1016/j.clinsp.2022.100042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/26/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Coronavirus 19 (COVID-19) pandemic has dramatically impacted liver organ transplantation. The American Society of Transplantation recommends a minimum of 28 days after symptom resolution for organ donation. However, the exact time for transplantation for recipients is unknown. Considering that mortality on the waiting list for patients with MELD >25 or fulminant hepatitis is higher than that of COVID-19, the best time for surgery after SARS-CoV-2 infection remains undetermined. This study aims to expand the current knowledge regarding the Liver Transplantation (LT) time for patients after COVID-19 and to provide transplant physicians with essential decision-making tools to manage these critically ill patients during the pandemic. METHODS Systematic review of patients who underwent liver transplantation after diagnosis of COVID-19. The MEDLINE, PubMed, Cochrane, Lilacs, Embase, and Scielo databases were searched until June 20, 2021. The MESH terms used were "COVID-19" and "Liver transplantation". RESULTS 558 articles were found; of these 13 articles and a total of 18 cases of COVID-19 prior to liver transplantation were reported. The mean age was 38.7±14.6, with male prevalence. Most had mild symptoms of COVID. Five patients have specific treatment for COVID-19 with convalescent plasm or remdesivir/oseltamivir, just one patient received hydroxychloroquine, and 12 patients received only symptomatic treatment. The median time between COVID-19 to LT was 19 days (13.5‒44.5). Deceased donor liver transplantation accounted for 61% of cases, while living donor transplantation was 39%. CONCLUSION Despite the concerns regarding the postoperative evolution, the mortality of patients with high MELD or fulminant hepatitis transplanted shortly after COVID-19 diagnosis does not seem to be higher. (PROSPERO, registration number = CRD42021261790).
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Affiliation(s)
- Lucas S Nacif
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Michel Ribeiro Fernandes
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniel R Waisberg
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rafael S Pinheiro
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vinicius Rocha-Santos
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flávio Galvão
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wellington Andraus
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Carneiro-D'Albuquerque
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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29
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Millán DAC, Fajardo-Cediel W, Tobar-Roa V, García-Perdomo HA, Autrán-Gómez AM. Strategies to Mitigate the Impact of COVID 19 Pandemic on Organ Donation and Kidney Transplantation in Latin America. Curr Urol Rep 2021; 22:59. [PMID: 34913144 PMCID: PMC8724642 DOI: 10.1007/s11934-021-01076-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW COVID-19 pandemics have severely affected Latin America. It has resulted in SARS-CoV-2-associated clinical adverse outcomes, but also in social and economic deterioration. Consequently, it generated a significant negative impact on organ donation and kidney transplantation (KTx) activity in our region, leading to a negative impact on these patients' survival and quality of life. For this reason, this article aimed to describe applicable logistics, organizational and clinical strategies to mitigate the effect of the COVID-19 pandemic on kidney donation and transplantation in our region. RECENT FINDINGS Absenteeism to hemodialysis sessions in patients with end-stage renal disease has been described in up to 54% in Latin America. Not surprisingly, there was a reduction in organ donation and transplants between 21 and 59%. Also, there is a higher incidence of COVID-19 positive tests in the waiting list population than KTx recipients (9.9%). However, there was a higher mortality rate in KTx recipients than the waiting list population (32%). Additionally, 59% of living donor kidney transplant programs suspended the evaluation of new donors due to the COVID-19 pandemic. Throughout this manuscript, we summarize some practical tips to resume organ donation and KTx during pandemics in Latin America, such as selecting healthy donors and recipients, universal SARS-CoV-2 screening, implementing COVID-19 accessible pathways, and telehealth as a standard, and postpone all non-urgent visits.
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Affiliation(s)
- David Andrés Castañeda Millán
- Department of Surgery, Urology Unit, Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, Colombia.
| | | | - Verónica Tobar-Roa
- Urology Department and Kidney Transplant Unit, Clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | - Ana María Autrán-Gómez
- Oficina de Investigación Confederación Americana de Urologia (CAU), Buenos Aires, Argentina
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30
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Fonseca EA, Feier F, Pugliese R, Freitas AF, Porta G, Miura I, Baggio V, Kondo M, Benavides M, Vincenzi R, Roda K, Oliveira CV, Chapchap P, Seda‐Neto J. Pediatric liver transplantation activity in a high-volume program during the COVID-19 pandemic in Brazil. Pediatr Transplant 2021; 25:e14112. [PMID: 34396644 PMCID: PMC8420104 DOI: 10.1111/petr.14112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of the COVID pandemic on liver transplant (LT) programs varied among countries. Few data are available about that impact in pediatric liver transplant (PLT) programs. This study aimed at comparing the data of our program in Brazil (2019 vs. 2020). METHODS Retrospective cohort study. RESULTS One hundred and seventy-four PLT were performed in the period (93% living donors). Patients were divided into two groups according to the LT date: pre-COVID-19 period (march/2019-February/2020) and COVID-19 period (March/2020-February 2021). In the pre-COVID-19 period, 97 LTs were performed, and 77 LTs were performed in the COVID-19 period. Patients in the COVID-19 period were younger (10.9 months vs. 16 months, p 0.009), had higher PELD scores (15 vs. 14, p 0.04), more ascites (66.2 vs. 51.5%, p 0.03), and more frequently hospitalized before LT (27.3 vs. 17.5%). However, there was no difference in post-LT complications, retransplantation nor survival rates. Six (6.2%) patients from pre-COVID-19 period were COVID positive at a median of 15.5 months (14-17.5), and 6 (7.8%) patients from COVID-19 period were COVID positive at a median of 3 months (20 days-6 months) from LT. There was neither mortality nor complications in those patients. Four (33%) were hospitalized, and one had prolonged intubation. Four (33%) were asymptomatic, 4 (33%) had upper airways symptoms, and the remaining had gastrointestinal symptoms. CONCLUSION Overall, PLT was not affected during COVID-19 period. Even though patients from COVID-19 period were sicker, there was no significant impact in LT outcomes. All the recipients who tested positive for COVID had a favorable outcome.
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Affiliation(s)
- Eduardo A. Fonseca
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Flavia Feier
- Hepatology and Liver TransplantationSanta Casa de Porto AlegrePorto AlegreBrazil
| | - Renata Pugliese
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Aline F. Freitas
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Gilda Porta
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Irene Miura
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Vera Baggio
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Mario Kondo
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Marcel Benavides
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Rodrigo Vincenzi
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Karina Roda
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Caio V. Oliveira
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - Paulo Chapchap
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
| | - João Seda‐Neto
- Hepatology and Liver TransplantationHospital Sírio‐LibanêsSão PauloBrazil,Hepatology and Liver Transplantation A. C. Camargo Cancer CenterSão PauloBrazil
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31
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Santos A, Sousa LLD, Calça R, Lima A, Nascimento C, Jorge C, Adragão T, Bruges M, Peres S, Weigert A. SARS-CoV-2 infection in kidney transplant recipients: clinical impact and outcomes - a single center experience. J Bras Nefrol 2021; 44:376-382. [PMID: 34812470 PMCID: PMC9518613 DOI: 10.1590/2175-8239-jbn-2021-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Kidney transplant recipients are a subgroup of patients at higher risk of critical forms of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and poor outcomes due to immunosuppression treatment. Herein, we present data from a single center cohort of kidney transplant recipients with SARS-CoV-2 infection. Methods: In a prospective study, baseline characteristics, clinical features, antiviral and immunosuppression management were compared between outpatients and hospitalized patients, during a one-year period. Results: Seventy-seven kidney transplant recipients were analyzed, including outpatients and hospitalized patients, with a median age of 57.7 (IQR 49.7-64.9) years. Twenty-eight (36.4%) were managed as outpatients, while 49 (63.6%) patients required hospital admission. Among hospitalized patients, 18.4% were admitted in ICU, 49% had AKI, and 20.4% died. Immunosuppression adjustments were performed in 95.9% of hospitalized patients, with dose of anti-metabolites adjusted in 83.7%, mTOR inhibitors in 14.3%, calcineurin inhibitors in 12.2%, and corticosteroid therapy in 81.6%. Conclusion: Among hospitalized patients, immunosuppression management included reduction or withdrawal of anti-metabolite and increase of corticosteroid dose. AKI occurred in almost half of patients and mortality in hospitalized patients reached 20%, reflecting greater disease severity than the general population.
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Affiliation(s)
- Afonso Santos
- Hospital Professor Fernando da Fonseca, Departamento de Nefrologia, Amadora, Portugal
| | - Luís Leite de Sousa
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Rita Calça
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Anna Lima
- Hospital Professor Fernando da Fonseca, Departamento de Nefrologia, Amadora, Portugal
| | - Célia Nascimento
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Cristina Jorge
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Teresa Adragão
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Margarida Bruges
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Susana Peres
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Departamento de Doenças Infecciosas, Lisboa, Portugal
| | - André Weigert
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
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32
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Kute VB, Fleetwood VA, Meshram HS, Guenette A, Lentine KL. Use of Organs from SARS-CoV-2 Infected Donors: Is It Safe? A Contemporary Review. CURRENT TRANSPLANTATION REPORTS 2021; 8:281-292. [PMID: 34722116 PMCID: PMC8546195 DOI: 10.1007/s40472-021-00343-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW As the prevalence of individuals with recovered coronavirus disease 2019 (COVID-19) increases, determining if and when organs from these donors can be safely used is an important priority. We examined current knowledge of outcomes of transplant using donors with recovered COVID-19. RECENT FINDINGS A literature search of PubMed and Google scholar databases was conducted to identify articles with terms "SARS-CoV2," "COVID-19," "donor recovered," and "transplantation" published through 08/10/2021. We identified 25 reports detailing 94 recipients of both abdominal and thoracic transplants from donors with both prior and active COVID-19 infection. Rates of transmission to the recipient and of transplanted organ dysfunction were low among reports of donors with prior COVID-19 infection. End organ dysfunction and transmission were more common with active infection, although few reports are available. Standardized reporting is needed to better assess the impact of donor symptomatology, cycle thresholds, and individual recipient risk factors on postoperative outcomes. SUMMARY Available reports suggest that transplantation from COVID-19 donors may be feasible and safe, at least in short term follow-up. Nevertheless, there is a need for standardized testing and management protocols which should be tailored for available resources. While increased availability of COVID-19 vaccinations will mitigate risks of donor-derived COVID-19 and simplify management, continued vigilance is warranted during the ongoing public health emergency.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Vidya A. Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Alexis Guenette
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO USA
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33
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BJS Commission Team, Abahuje E, Abbas A, Abd El Aziz Abd El Maksoud M, Abdelhady A, Abdelhamid S, Abdelkarem Ahmed Faraj H, Abdelqader B, Abdou H, Abdullah A, Abedua Harrison M, Abem Owusu E, Aboalazayem A, Aboulhosn R, Abu Oda S, Abubakar A, Abutaka A, Acevedo Fontalvo D, Acuna S, Adefemi A, Adegbola S, Adenuga T, Adeyeye A, Adil Hilmi A, Aditya K, Adjeso T, Aftab R, Afzal A, Aggarwal V, Aggarwal A, Aguilera R, Aguilera-Arévalo ML, Aguirre Salamanca EJ, Aguirre-Allende I, Ahari D, Ahmad H, Ahmad Rauf F, Ahmad Zartasht Khan A, Ahmed S, Ahmed Fieturi N, Ahmed Mohamed S, Ahmed-Bakhsh Z, Ahsan Javed M, Akano L, Akbar A, Akhbari M, Akhmedov P, Aksit G, Akula Y, Al Majid S, Al Mukhtar O, Al Omran H, Al-Asali N, Al-Azzawi M, Al-Habsi R, Al-Iraqi H, Al-Naggar H, Alameer E, Albirnawi H, Aldulaijan F, Alejandro Miranda Ojeda R, AlHasan A, Ali S, Ali A, Ali Khan M, Alimova Y, Aljanadi F, Aljubure R, Allopi N, Almedbal H, Almubarak M, Alqaidoom Z, Alselaim N, Alshaar M, Alshammari R, Altaf K, Altıner S, Altunpak B, Alvarez Lozada LA, Amal Nahal E, Amer A, Amin K, Aminu U, Amisi Numbi N, Amjad T, Amoah R, An Y, Anastasopoulos NA, Andrés Urrutia J, Angarita F, Angarita KL, Ángel FreirÍa Eiras M, Antypas A, Anwar MA, Anwar H, Apampa TO, Apostolou K, Aquina C, Arachchige Adithi Himika Randeni R, Archila Godínez MI, et alBJS Commission Team, Abahuje E, Abbas A, Abd El Aziz Abd El Maksoud M, Abdelhady A, Abdelhamid S, Abdelkarem Ahmed Faraj H, Abdelqader B, Abdou H, Abdullah A, Abedua Harrison M, Abem Owusu E, Aboalazayem A, Aboulhosn R, Abu Oda S, Abubakar A, Abutaka A, Acevedo Fontalvo D, Acuna S, Adefemi A, Adegbola S, Adenuga T, Adeyeye A, Adil Hilmi A, Aditya K, Adjeso T, Aftab R, Afzal A, Aggarwal V, Aggarwal A, Aguilera R, Aguilera-Arévalo ML, Aguirre Salamanca EJ, Aguirre-Allende I, Ahari D, Ahmad H, Ahmad Rauf F, Ahmad Zartasht Khan A, Ahmed S, Ahmed Fieturi N, Ahmed Mohamed S, Ahmed-Bakhsh Z, Ahsan Javed M, Akano L, Akbar A, Akhbari M, Akhmedov P, Aksit G, Akula Y, Al Majid S, Al Mukhtar O, Al Omran H, Al-Asali N, Al-Azzawi M, Al-Habsi R, Al-Iraqi H, Al-Naggar H, Alameer E, Albirnawi H, Aldulaijan F, Alejandro Miranda Ojeda R, AlHasan A, Ali S, Ali A, Ali Khan M, Alimova Y, Aljanadi F, Aljubure R, Allopi N, Almedbal H, Almubarak M, Alqaidoom Z, Alselaim N, Alshaar M, Alshammari R, Altaf K, Altıner S, Altunpak B, Alvarez Lozada LA, Amal Nahal E, Amer A, Amin K, Aminu U, Amisi Numbi N, Amjad T, Amoah R, An Y, Anastasopoulos NA, Andrés Urrutia J, Angarita F, Angarita KL, Ángel FreirÍa Eiras M, Antypas A, Anwar MA, Anwar H, Apampa TO, Apostolou K, Aquina C, Arachchige Adithi Himika Randeni R, Archila Godínez MI, Arez O, Armonis P, Arshad S, Arshad Salman M, Arshid A, Arteaga Asensio PC, Arthur T, Arumuga Jothi A, Aryo Damara F, Asensio Gomez L, Ashcroft J, Ashraf S, Asif A, Asif A, Atif M, Attaullah Khan M, Avellaneda N, Awad S, Awadh M, Axiaq A, Ayad Mohammed Shuwayyah A, Ayalew D, Aytac E, Azam F, Azevedo J, Azhar B, Aziz J, Aziz A, Azzam A, Baba Ndajiwo A, Baig M, Baker D, Bakko F, Balachandran R, Balachandran G, Balagizi Mudekereza J, Balai E, Balci B, Balduzzi A, Balhareth A, Bandyopadhyay S, Bandyopadhyay S, Banerjee D, Bangalore Mahalinga D, Bankhead-Kendall B, Bankole NDA, Banwell V, Baris Bengur F, Baris Ozmen B, Barnard M, Barnett R, Barreras Espinoza JA, Barrios A, Bass G, Bass M, Bausys A, Bavikatte A, Bayram J, Beamish A, Beattie C, Belia F, Bellato V, Bellikatti S, Benjamens S, Benlice C, Bennedsgaard S, Bennett S, Bentounsi Z, Bergenfeldt H, Bhandoria G, Bhatia M, Bhatti MT, Bilgili Z, Bislenghi G, Bisset C, Biswas S, Blake J, Blanco R, Boccalatte L, Boden R, Bojanic C, Boland M, Boland P, Bollen E, Bonci EA, Booth A, Borakati A, Borunda Escudero GE, Bosco SJ, Boström P, Botelho de Alencar Ferreira Cruz P, Bouchagier K, Bouhuwaish A, Boutros M, Boyce K, Boyle C, Bradshaw L, Brandl A, Brar A, Brenkman H, Brennan C, Brines C, Brookmyre A, Brosnan C, Brouwers L, Brown A, Brown L, Brown C, Brown C, Brown J, BS V, Buksh M, Bunani Emmanuel M, Burbano D, Burelli A, Burke A, Burke J, Burlov N, Burns A, Burton O, Butt A, Buzra Ozkan B, Cabrera Silva L, Caicedo EY, Calderbank T, Cambridge W, Campelo G, Can Tatar O, Carbone F, Carrano F, Casallas D, Casanova Portoles D, Casciani F, Cassimjee I, Castañeda Ramírez OA, Catalán V, Caviedes J, Cayetano L, Ceresoli M, Chan M, Chan V, Chandrasinghe P, Chapman S, Chaturvedi A, Chaudhry D, Chaudry H, Chen HW, Cheng A, Chernykh M, Cheruiyot I, Cheung J, Chia C, Chica J, Chinai N, Chirwa A, Chiwaligo J, Choi A, Choi J, Chowdhury MR, Christopher E, Christou N, Chu T, Chua D, Chua HW, Chung C, Cihat Yildirim A, Cillo M, Cioffi S, Claireaux H, Clermonts S, Clifford R, Climent M, Clynch A, Coelen RJ, Colás-Ruiz E, Collar A, Collard M, Connelly T, Connor K, Correia de Sá T, Coşgun Acar N, Costa T, Couch D, Cowper S, Creavin B, Crook B, Curell A, D’alessio R, Dale J, Damgaard Eriksen J, Dario Martin Gonzalez I, Darwish A, Das M, Das R, Das K, Dave R, David SO, Davies T, Davis C, Davison S, Davletshina V, Dawidziuk A, Dawson A, de Andres Crespo M, de Berker H, de Dieu Ngo P, de la Caridad Espinosa Luis R, de Lacy B, de Montserrat Medina Sifuentes A, De Silva S, del Rio C, Delaune V, Dell A, Demirbaş I, Demirli Atici S, Deniz Tepe M, Derebey M, Desai G, Desai M, Devarakonda S, Deveras N, Di Franco G, Di Martino M, Di Martino M, Di Marzo F, Díaz Á, Diaz del Gobbo G, Diaz-Castrillon C, Dick L, Dickinson K, Diego E, Dimasi I, Dingemans S, Dixon L, Dixon B, Doherty W, Dooreemeah D, Dornseifer M, Dossa F, Dossou W, Drake T, Drami I, Drevin G, du Plessis MC, Dudi-Venkata N, Dudley R, Duffy S, Duklas D, Dumbrava BD, Duygu Avlar F, Dworzynska A, Ebrahim W, Ebrahim A, Efrén Lozada Hernández E, Ehigie N, El Boghdady M, El Hasnaoui C, El Sheikh M, El-Hussuna A, Eldurssi O, Elfeki H, Elhadi M, Elhassan M, Elhissi A, Elliot B, Elsenbroek C, Elsolh B, Elson N, Eltyeb H, Emerson H, Endalle G, English W, Ercisli C, Espinosa G, Essam Abdelraheem M, Essangri H, Etienne P, Evans T, Ezeme C, Ezzahraa F, Fadalla T, Fagan J, Fahmy M, Fairfield C, Falade O, Famularo S, Faqar-Uz-Zaman F, Farid Y, Farooq A, Farooq H, Farooqui F, Farquharson B, Faruqi A, Faulder R, Faut M, Fechner K, Feenstra T, Fehervari M, Fernandez L, Fernández Alberti J, Ferrario L, Field D, Fiore L, Fleming N, Fleming C, Florial E, Fok M, Fokin D, Foley M, Forero MP, Fornasiero M, Fowler H, Fowler G, Franchi E, Franklin L, Fredriksson Å, Fruhling P, Fuentes Navarrette G, Fülöp A, Furtado M, Galbraith N, Gallo G, Gana T, Gaskin E, Gasparini M, Gatan RG, Geary E, Gelaye Wudineh K, Gemenetzis G, Georgi M, Ghalige H, Ghareeb W, Ghatwary Tantawy T, Ghomsi C, Ghuman A, Giannakis P, Giron F, Gjengedal K, Gkotsis E, Glasbey J, Godahewa S, Godula D, Goffredo P, Goh S, Golriz M, Gomez L, Gomez Gomez D, Gonzalez R, Gonzalez D, Gonzalez Gutierrez E, Gopar D, Gordini L, Gori A, Gortázar S, Gousy N, Gowda R, Gowda M, Gqada J, Grechenig M, Greer J, Gregório L, Grigorova A, Grimes H, Groot V, Gruber R, Grüter A, Guest R, Gujjuri R, Gülçek E, Gulcu B, Gull K, Gulmez M, Gupta V, Gutlic A, Guven T, Gwatirisa T, Gwini G, Gwodog P, Gysling S, Habib M, Hafeez Bhatti AB, Hallesmith J, Hamza Sadiq M, Haney C, Hanna N, Hanna L, Hannington M, Harbjerg J, Haribaskaran D, Harran N, Harrington B, Hasan R, Hashmi S, Hassan M, Hassan M, Hassan A, Haverkamp L, Hazen S, Heer B, Heil J, Helliwell J, Henriksen N, Henshall D, Hermanson M, Hermena S, Hettiarachchi D, Hextall C, Hidalgo M, Hidayat H, Hider A, Higgins P, Hirani D, Hirpara D, Hisham I, Hite M, Hoh SM, Holmberg C, Hölmich E, Holst F, Hossam A, Hossam Elfallal A, Howard P, Huaman E, Huang Y, Huang L, Huang D, Huber T, Hugh J, Hughes J, Hüttner F, Huynh R, Hylands A, Iannuzzi J, Ielpo B, Iftikhar Talib A, Ignacio J, Ignatavicius P, Ike S, Ikwu C, Inama M, Ing A, Isik A, Islam N, AlHasan AJMS, Perez Rivera CJ, Jácome F, Jaffer T, Jagiella-Lodise O, Jain M, Jain M, Jain K, Jakubauskas M, Jalal M, James H, Jang Y, Janssen B, Jansson H, Jariod-Ferrer Ú, Javanmard H, Javed S, Jayarajah U, Jayasuriya I, Je J, Jessop Z, Jia Lin Tang E, Jiang H, Jiayan Y, Jih Huei T, Jimenez-Rodriguez R, Joh D, Johnson A, Jones N, Jones C, Jordan C, José J, José Núñez Ju J, José Pizarro M, Jose Salazar C, Joseph J, Joseph J, Justiniano C, Kabir T, Kalfountzos C, Kalogiannaki E, Kalyanasundaram K, Kamarajah S, Kamil Quraishi M, Kapila A, Kapila V, Karagiannidis G, Kashif M, Kathiravelupillai S, Kathiravelupillai A, Katsogridakis E, Kaur K, Kaur Sekhon Inderjit Singh H, Kausur N, Kawka M, Keehan G, Kehlet Watt S, Kelly M, Kelvin Egbuchulem I, Kembuan G, Khajeh E, Khaled Elfaitur A, Khan MF, Khan S, Khan M, Khan D, Khan H, Khatkar H, Khaw R, Kim B, Kishore Siddiraju K, Kitua D, Kırımtay B, Kmezić S, Knight S, Knight S, Koëter T, Koh A, Koh Hong Xiang F, Kojo Anyomih T, Kokelaar R, Koliarakis I, Kolli S, Kong J, Kong J, König D, Koshy M, Kourdouli A, Kowal M, Kraima A, Kramer F, Kryzauskas M, Kuchynskyi I, Kuemmerli C, Kuiper S, Kumar S, Kumar A, Kumar A, Kumar L, Kumar H, Kumar N, Kumar S, Kumar Bandyopadhyay S, Kumar Garg P, Kumar Venkatappa S, Kung J, Kural S, Kushairi A, Kuuzie E, Kvietkauskas M, Kwek I, La J, Lai L, Lakpriya S, Lam K, Lami M, Lapolla P, Larsen H, Latif J, Laudari U, Laurnezi A, Lawal A, Lawday S, Lederhuber H, Lednev A, Lee R, Lee R, Lefevbre G, Lesmus M, Leyva Moraga FA, Leyva Moraga E, Leyva Moraga F, Li HL, Li Z, Licardie E, Light A, Lin A, Lincango E, Litta F, Liu H, Lofthouse B, Londoño MA, Lopes R, Lopes de Freitas R, Lopez L, López AI, Lopez-Gomez J, Lopez-Pena G, Lowe R, Lowe D, Lowey M, Loy G, Lozanovski V, Luzon J, Lynn P, Maccabe T, Machielsen A, Mafla Herrería CA, Maggino L, Mahmood D, Mahmoud M, Mahtani K, Maitra I, Maji S, Majiet I, Mal L, Mal L, Malherbe J, Malhotra K, Malkomes P, Man E, Manan Sheikh A, Manjunath S, Manzano Nuñez R, Manzoor S, Maqsood R, Marchegiani G, Marchegiani G, Marchegiani F, Marín D, Marin A, Marks I, Marks I, Marson E, Martensen A, Martin D, Martín Martín G, Martin-Perez B, Martinez P, Marwaha P, Mashauri C, Mashbari H, Masior Ł, Masri R, Masud L, Masudi S, Mateu Calabuig G, Math S, Matrachisia A, Mazingi D, Mazzotta A, McAlinden J, McCabe G, McColm L, McElvaney H, McGivern K, McGovern J, McGuinness E, McInerney N, Mckay S, McKee C, McKenna M, McKenna N, McLean K, Mediratta S, Medkova Y, Medzhidov O, Mehraj A, Mekhael M, Mekinde O, Mellenthin C, Melucci A, Mentor K, Merchant J, Messias H, Meza C, Mhango P, Miladinov M, Milagros Niquen Jimenez M, Miller P, Mills E, Milton A, Mischlinger H, Möckli B, Modi R, Mohamed HM, Mohamed M, Mohamed Abulghasm T, Mohammad SA, Mohammed TO, Mohammed A, Mohan H, Mohan M, Moin I, Mok V, Molina G, Moloney J, Moneim J, Monfort Mira M, Montcusí Ventura B, Montouri M, Moossdorff M, Mora-Guzmán I, Moran B, Morán RAR, Moreno-Ordaz S, Morera Á, Morgan R, Morley R, Moro-Valdezate D, Moros S, Moss JL, Moynihan A, Moyón M, Muduli N, Mugla N, Mugla W, Müller P, Mun G, Mundhada R, Munir I, Muñoz F, Muñoz E, Muñoz A, Muñoz Balderas DC, Murgitroyd E, Murray V, Murthy S, Mushiwokufa W, Mustafa H, Mustakimov B, Mutambanengwe P, Myint P, Nadkarni S, Nadkarni S, Nahar S, Naidoo P, Nam R, Nandhra S, Nanjappa N, Narasimhan V, Nardi W, Nasir M, Nasir M, Naughton A, Naumann D, Navarro S, Nawaaz Karimbocus M, Nazir A, Ndereya S, Ndong A, Negoi I, Nel D, Nelson D, Nepal S, Neufeld J, Ng J, Ng J, Ng D, Ng CE, Ng J, Ngaserin S, Ngu L, Ngwenya E, Fhearaigh RN, Nikolousakis TK, Ninkovic M, Nita G, Nitschke C, Noren E, Noton T, Novikova A, Nowinka Z, Nyakunengwa T, Nyalundja A, Nzenwa I, Kristensen HØ, O’Brien L, O’Brien S, O’Reilly J, O’Rourke S, O’Sullivan M, O’Dwyer M, Ochieng L, Oderoha E, Oh KE, Öhlberger L, Ölçüm M, Olkina A, Omkumar M, Omnitel B, Oncel Yakar D, Ong K, Ong Wei Lin L, Ooi R, Ooi S, Oomman A, Oon Tyjet D, Opiyo S, Oscullo Yepez JJ, Osei-kuffour N, Osunronbi T, Ottlakán A, Oussama Kacimi S, Ovaere S, Ozair A, Pachler F, Pai Oo S, Paiella S, Panaiotti L, Panda N, Pandarinath S, Pandey D, Pandrowala S, Pandrowala S, Papa Mamadou F, Paranathala M, Park J, Parmar C, Parvez A, Pasovic L, Pasquer A, Pasumarthy N, Pata F, Patel T, Patel P, Patel N, Patel M, Patel P, Patron Uriburu N, Patrone R, Paul A, Pavan Kumar OM, Pavithran A, Pedraza Ciro M, Peloso A, Peña Gallardo MT, Peña Velazquez A, Perea J, Pérez-Sánchez LE, Perra T, Perrotta G, Petersson P, Petra G, Petrucciani N, Pickin C, Pino V, Pinotti E, Pinto F, Plum P, Podesta F, Pollini T, Pompeu Sá M, Ponce Leon F, Ponniah HS, Ponte de Sousa X, Ponton J, Pontula A, Popa M, Portilla AL, Posner F, Potolicchio A, Pouwels S, Povo A, Prasad P, Preciado S, Preece R, Proud D, Pulido Segura JA, Puliyath N, Qui M, Quimbaya Rodríguez AS, Raby-Smith W, Racoviţă A, Radwan R, Rafaih Iqbal M, Rafik A, Raguan B, Rahi M, Rahiri JL, Rahme J, Rai L, Raj A, Raj Saksena A, Raja M, Ramirez J, Ramzi J, Rao C, Rashid A, Ratnayake B, Rattanasirivilai K, Raubenheimer K, Ravikumar N, Ravn S, Razoz N, Rea W, Regan A, Rela M, Remme A, Rey Chaves CE, Reyes A, Riad A, Rice D, Rios Quintana K, Ritter A, Roalsø M, Robinson D, Rodriguez J, Rodríguez F, Rodriguez MC, Rogers A, Rohila J, Romanyuc D, Romic I, Rommaneh M, Rompianesi G, Rosa F, Roscio F, Rose A, Rotimi T, Ruiz H, Ruiz Yucuma J, Ruiz-Úcar E, Ruslan M, Rutegård M, Ryan Harper E, Ryckx A, Rydbeck D, Sá-Marta E, Sadien I, Safari Nteranya D, Sagoo K, Sakata S, Saladino E, Saleem A, Saleem S, Salehi M, Salih S, Sallinen V, Salvans S, Sam ZH, Samadov E, Emile SH, Sampaio Alves M, Sanad A, Sánchez Fonseca S, Sanchez Teran A, Sanchez Ussa S, Sanchez Ussa S, Sandli O, Sanghera J, Sani I, Santafe Guerrero M, Sante Fornasiero M, Santes Jasso O, Santos Pereira I, Santos Sousa H, Saratzis A, Sarmiento Alarcon A, Saumtally T, Sayyed R, Schettino M, Schleimer L, Schmidt T, Schondffelt K, Schwab M, Scott A, Searle H, Sebopelo L, Seeglier B, Seishima R, Semenvov D, Senent-Boza A, Sepulveda J, Serenari M, Serrano Navidad M, Sert I, Sewart E, Sgrò A, Shadrina V, Shah K, Shahid F, Shalaby M, Shankar B, Shapiro J, Sharma L, Sheel A, Shenfine A, Shenoy S, Sherif A, Shetty N, Shetty R, Sia TC, Sichimba D, Siddique H, Siddiqui I, Simkens G, Simon H, Sinan L, Singh T, Singh K, Singh Y, Sinha L, Siragusa L, Sluckin T, Smart YW, Smith H, Smits L, Sneep-van Kessel C, Sohrabi C, Solórzano Pineda O, Soma A, Sooriyapiragasam L, Sparavigna M, Spence R, Spencer N, Spiers H, Sprakel J, Sravanam S, Srinivasan M, Srinivasan R, Staniszewska A, Stasinos K, Steinholt I, Steinruecke M, Stephen BJ, Stijns J, Still M, Stupalkowska W, Subba S, Sucharitkul P, Sudarsanam A, Sudhamsh Reddy D, Suhardja T, Suliman M, Sunilkumar A, Suresh N, Sussmes S, Sutton P, Syltern J, Taha A, Takamizawa Y, Takoutsing Dongmo AB, Tamás T, Tan L, Tan JL, Tan K, Tan E, Tan Yong Hui A, Tanase A, Tariverdiev A, Tasnem A, Tatar C, Tay E, Tejedor P, Tesfaye G, Tetinou F, Thorpe C, Thyø A, Tlelo Amastal D, Tolani M, Tolga Saracoglu K, Tölgyes T, Torrent Jansà L, Toscano Igartua S, Tovani Palone MR, Traff H, Trevis J, Tummers W, Tur A, Turchenko I, Uche V, Uddin A, Udonsak N, Ullah M, Urbonas T, Uwins C, Uy Magadia E, Uzair Qureshi A, Uzun K, Vadim P, Valarche G, Valdez Gonzalez RA, van Beek DJ, van Dalen AS, van den Hondel D, van der stok E, van Dorp M, van Oostendorp S, van Praag E, van Rees J, van Silfhout L, Varga Z, Varghese S, Varghese C, Varghese J, Vasilica AM, Vásquez Ojeda X, Vega E, Vehler S, Venchiarutti R, Vengatesan S, Venn M, Verma D, Vianey Partida Nava G, Victoria D, Vieira P, Vilar Alvarez ME, Vinci D, Viscasillas Pallàs G, Viswanath M, Vivanco J, Vizcaya Rodríguez V, Vo J, Volchanski D, Voron T, Voronovskyi Y, Vu J, Wadhwa M, Wadhwa S, Wagner G, Wallace M, Wang YY, Wang J, Wani A, Wanigasooriya K, Wanjara S, Wanjiku N, Warner C, Wei Leow T, Wellington MJ, Wells C, Wenzelberg C, Wettstein D, Wezel A, Wheldon L, Widmer L, Wijayaratne T, Wijeyaratne M, Wilkin R, Williams E, Willis F, Winter D, Wirsik MM, Wishah B, Wong G, Wong WJ, Wong K, Wong KY, Worku D, Wright E, Wright J, Wright J, Wright OW, Xenacki S, Xia W, Xu W, Xu Z, Yalcinkaya A, Yang W, Yang PC, Yanishev A, Yanzon de la Torre A, Yao H, Yaqoob E, Yen Ling Quake S, Yeo D, Yeom B, Yershov D, Yiasemidou M, Yildiz A, Yiu A, Yong E, Yoshimura R, Younis MU, Younis Ringshawl Z, Youssef M, Yue Y, Yuen S, Yuldashev R, Yurttas C, Yves B, Zaborowski A, Zackeri R, Zafar A, Zahra W, Zaidi A, Zainudin S, Zakeri R, Zamora I, Zamora AT, Zawistowski M, Zbikowska G, Zegers W, Zehra S, Zeyra A, Zhagniyev Z, Zivanovic M, Zmuc J, Zope M, Zubayraeva A, Zucker B. BJS commission on surgery and perioperative care post-COVID-19. Br J Surg 2021; 108:1162-1180. [PMID: 34624081 DOI: 10.1093/bjs/znab307] [Show More Authors] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
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MESH Headings
- Adult
- Biomedical Research/organization & administration
- COVID-19/diagnosis
- COVID-19/economics
- COVID-19/epidemiology
- COVID-19/prevention & control
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Female
- Global Health
- Health Resources/supply & distribution
- Health Services Accessibility/trends
- Humans
- Infection Control/economics
- Infection Control/methods
- Infection Control/standards
- International Cooperation
- Male
- Middle Aged
- Pandemics
- Perioperative Care/education
- Perioperative Care/methods
- Perioperative Care/standards
- Perioperative Care/trends
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/trends
- Surgeons/education
- Surgeons/psychology
- Surgeons/trends
- Surgical Procedures, Operative/education
- Surgical Procedures, Operative/methods
- Surgical Procedures, Operative/standards
- Surgical Procedures, Operative/trends
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Thieme CJ, Anft M, Paniskaki K, Blazquez-Navarro A, Doevelaar A, Seibert FS, Hoelzer B, Justine Konik M, Meister TL, Pfaender S, Steinmann E, Moritz Berger M, Brenner T, Kölsch U, Dolff S, Roch T, Witzke O, Schenker P, Viebahn R, Stervbo U, Westhoff TH, Babel N. The Magnitude and Functionality of SARS-CoV-2 Reactive Cellular and Humoral Immunity in Transplant Population Is Similar to the General Population Despite Immunosuppression. Transplantation 2021; 105:2156-2164. [PMID: 33988334 PMCID: PMC8487706 DOI: 10.1097/tp.0000000000003755] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ability of transplant (Tx) patients to generate a protective antiviral response under immunosuppression is pivotal in COVID-19 infection. However, analysis of immunity against SARS-CoV-2 is currently lacking. METHODS Here, we analyzed T cell immunity directed against SARS-CoV-2 spike-, membrane-, and nucleocapsid-protein by flow cytometry and spike-specific neutralizing antibodies in 10 Tx in comparison to 26 nonimmunosuppressed (non-Tx) COVID-19 patients. RESULTS Tx patients (7 renal, 1 lung, and 2 combined pancreas-kidney Txs) were recruited in this study during the acute phase of COVID-19 with a median time after SARS-CoV-2-positivity of 3 and 4 d for non-Tx and Tx patients, respectively. Despite immunosuppression, we detected antiviral CD4+ T cell-response in 90% of Tx patients. SARS-CoV-2-reactive CD4+ T cells produced multiple proinflammatory cytokines, indicating their potential protective capacity. Neutralizing antibody titers did not differ between groups. SARS-CoV-2-reactive CD8+ T cells targeting membrane- and spike-protein were lower in Tx patients, albeit without statistical significance. However, frequencies of anti-nucleocapsid-protein-reactive, and anti-SARS-CoV-2 polyfunctional CD8+ T cells, were similar between patient cohorts. Tx patients showed features of a prematurely aged adaptive immune system, but equal frequencies of SARS-CoV-2-reactive memory T cells. CONCLUSIONS In conclusion, a polyfunctional T cell immunity directed against SARS-CoV-2 proteins as well as neutralizing antibodies can be generated in Tx patients despite immunosuppression. In comparison to nonimmunosuppressed patients, no differences in humoral and cellular antiviral-immunity were found. Our data presenting the ability to generate SARS-CoV-2-specific immunity in immunosuppressed patients have implications for the handling of SARS-CoV-2-infected Tx patients and raise hopes for effective vaccination in this cohort.
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Affiliation(s)
- Constantin J. Thieme
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz, Berlin, Germany
| | - Moritz Anft
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Krystallenia Paniskaki
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Arturo Blazquez-Navarro
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz, Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Adrian Doevelaar
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Felix S. Seibert
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Bodo Hoelzer
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Margarethe Justine Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Toni L. Meister
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Stephanie Pfaender
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Eike Steinmann
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Marc Moritz Berger
- Department of Anesthesiology, University Hospital Essen, University Duisburg-Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology, University Hospital Essen, University Duisburg-Essen, Germany
| | - Uwe Kölsch
- Department of Immunology, Labor Berlin GmbH, Berlin, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Toralf Roch
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz, Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Richard Viebahn
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Ulrik Stervbo
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Timm H. Westhoff
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
| | - Nina Babel
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Charitéplatz, Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Germany
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Quante M, Brake L, Tolios A, Della Penna A, Steidle C, Gruendl M, Grishina A, Haeberle H, Guthoff M, Tullius SG, Königsrainer A, Nadalin S, Löffler MW. SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020. Transplant Proc 2021; 53:2421-2434. [PMID: 34551880 PMCID: PMC8364801 DOI: 10.1016/j.transproceed.2021.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, a huge number of case reports, case series, and consecutively various systematic reviews have been published reporting on morbidity and mortality risk connected with SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even for the expert reader. METHODS We performed a structured literature review comprising electronic databases, transplant journals, and literature from previous systematic reviews covering the entire year 2020. From 164 included articles, we identified 3451 cases of SARS-CoV-2-infected SOT recipients. RESULTS Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after coronavirus disease 2019 (COVID-19) was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT recipients. CONCLUSIONS COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT recipients with COVID-19.
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Affiliation(s)
- Markus Quante
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Linda Brake
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Tolios
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria; Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Vienna, Austria
| | - Andrea Della Penna
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Steidle
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Magdalena Gruendl
- Department of Epidemiology, Technical University Munich, Munich, Germany
| | - Anna Grishina
- Department of Pediatrics I, University Medicine Essen, Essen, Germany
| | - Helene Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Stefan G Tullius
- Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred Königsrainer
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Markus W Löffler
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany; Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany; Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany.
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Liver Transplant in a Polymerase Chain Reaction-Positive COVID-19 Recipient: A Case Report. Transplant Proc 2021; 53:2490-2494. [PMID: 34446305 PMCID: PMC8318687 DOI: 10.1016/j.transproceed.2021.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 01/31/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 coronavirus disease 2019 (COVID-19) global pandemic has ushered in an era of hesitation in performing transplants in affected patients. This stems from the paucity of data regarding the testing modalities, long-term implications, and uncertain prognosis in this group of patients. Current guidance from the Centers for Disease Control recommends assessing symptoms rather than polymerase chain reaction (PCR) positivity. In light of these recommendations, we describe a case of an orthotopic liver transplant in a patient infected with COVID-19 with persistent PCR positivity for 40 days before retransplant. The patient's perioperative and postoperative course was uncomplicated. Our experience leads us to advocate for liver transplants in patients who are PCR positive for COVID-19 after careful individualized and multidisciplinary evaluation regarding their liver disease and COVID-19 symptomatology.
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Mikolasevic I, Bozic D, Pavić T, Ruzic A, Hauser G, Radic M, Radic-Kristo D, Razov-Radas M, Puljiz Z, Milic S. Liver disease in the era of COVID-19: Is the worst yet to come? World J Gastroenterol 2021; 27:6039-6052. [PMID: 34629818 PMCID: PMC8476340 DOI: 10.3748/wjg.v27.i36.6039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/18/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
The global social, economic and political crises related to coronavirus disease 2019 (COVID-19) presumably had more indirect than direct negative impacts on health systems. Drastic lifestyle changes, social isolation and distancing, and individual and global financial crises resulted in robust populations forfeiting healthy habits and seeking comfort in alcoholic beverages, drugs and unhealthy diets. The inevitable consequences are increases in the incidence of nonalcoholic fatty liver disease, viral hepatitis, acute alcoholic hepatitis, liver cirrhosis decompensation and ultimately liver-related mortality. The inaccessibility of regular clinical and sonographic monitoring systems has caused difficulties in the treatment of patients with chronic liver disease (CLD) and has prevented prompt hepatocellular carcinoma detection and treatment. A dramatic reduction in the number of liver donors and the transformation of numerous transplantation centers into COVID-19 units drastically decreased the rate of orthotopic liver transplantation. The indirect, unavoidable effects of the COVID-19 pandemic in the following years have yet to be determined. Substantial efforts in the management of patients with liver disease in order to overcome the inevitable COVID-19-related morbidity and mortality that will follow have yet to be initiated. Several questions regarding the impact of the COVID-19 pandemic on liver disease remain. The most important question for general CLD patients is: How will the modification of clinical practice during this pandemic affect the outcomes of CLD patients? This article reviews the influence of COVID-19 on patients with liver disease during the pandemic, with particular emphasis on the disease course associated with pandemic resolution.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb 10000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Dorotea Bozic
- Department for Gastroenterology and Hepatology, University Hospital Center Split, Split 21000, Croatia
| | - Tajana Pavić
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Sestre Milosrdnice University Hospital Center, Zagreb 10000, Croatia
| | - Alen Ruzic
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
- Clinic for Cardiology, University Hospital Center Rijeka, Rijeka 51000, Croatia
| | - Goran Hauser
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
- Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
| | | | - Delfa Radic-Kristo
- Faculty of Medicine, Zagreb 10000, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb 10000, Croatia
| | | | - Zeljko Puljiz
- Department for Gastroenterology and Hepatology, University Hospital Center Split, Split 21000, Croatia
- University of Split, School of Medicine, Split 21000, Croatia
| | - Sandra Milic
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
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Kwapisz M, Małkowski P, Tronina O, Wasiak D, Czerwiński J, Polak WG, Kosieradzki M. Effects of the COVID-19 Pandemic on Solid Organ Transplantation During 2020 in Poland Compared with Countries in Western Europe, Asia, and North America: A Review. Med Sci Monit 2021; 27:e932025. [PMID: 34480012 PMCID: PMC8425269 DOI: 10.12659/msm.932025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which began in March 2020, affected organ donor acceptance and rates of heart, lung, kidney, and liver transplants worldwide. According to data reported to POLTRANSPLANT, the number of solid organ transplants decreased by over 35% and the number of patients enlisted de novo for organ transplantation was reduced to 70% of its pre-COVID-19 volume in Poland. Most transplant centers in Western Europe and the USA have also drastically reduced their activity when compared to the pre-pandemic era. Areas of high SARS-CoV-2 infection incidence, like Italy, Spain, and France, were most affected. Significant decreases in organ donation and number of transplant procedures and increase in waitlist deaths have been noted due to overload of the healthcare system as well as uncertainty of donor SARS-CoV-2 status. Intensive care unit bed shortages and less intensive care resources available for donor management are major factors limiting access to organ procurement. The impact of the COVID-19 outbreak on transplant activities was not so adverse in Asia, as a result of a strategy based on experience gained during a previous SARS pandemic. This review aims to compare the effects of the COVID-19 pandemic on solid organ transplantation during 2020 in Poland with countries in Western Europe, North America, and Asia.
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Affiliation(s)
- Magdalena Kwapisz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Małkowski
- Department of Surgical and Transplantation Nursing and Extracorporeal Therapies, Medical University of Warsaw, Warsaw, Poland
| | - Olga Tronina
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Wasiak
- Department of Surgical and Transplantation Nursing and Extracorporeal Therapies, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Czerwiński
- Department of Emergency Medicine, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- Polish Transplant Coordinating Center POLTRANSPLANT, Warsaw, Poland
| | - Wojciech G. Polak
- Department of Surgery, Division of Hepato-Pancreato-Biliary (HPB) and Transplant Surgery, Erasmus MC, Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Hillebrandt K, Nevermann N, Globke B, Moosburner S, Schmelzle M, Pratschke J. [Impact of the COVID-19 pandemic on hepato-pancreato-biliary surgery and organ transplantation]. Chirurg 2021; 92:918-923. [PMID: 34297148 PMCID: PMC8299733 DOI: 10.1007/s00104-021-01463-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
Hintergrund und Ziel der Arbeit Im Rahmen der COVID-19(„coronavirus disease 2019“)-Pandemie wurden weitreichende Ressourceneinschränkungen und -umverteilungen innerhalb des Gesundheitssystems notwendig. Diese Übersichtsarbeit beleuchtet die direkten und indirekten Folgen der COVID-19-Pandemie auf die Bereiche der hepatopankreatobiliären (HPB)-Chirurgie und Organtransplantation unter Berücksichtigung aktueller Literatur und veröffentlichter Expertenmeinungen nationaler und internationaler Fachgesellschaften. Entwicklungen der Operationszahlen wurden über die Eurotransplant Statistics Report Library und eine zentrumsinterne Auswertung HPB-chirurgischer Eingriffe analysiert. Ergebnisse In den Bereichen der HPB-Chirurgie und Organtransplantation zeigte sich vor allem in der ersten Pandemiewelle an vielen Zentren ein deutlicher Einbruch der Eingriffszahlen. Interessanterweise konnte meist kein kompensatorischer Zuwachs der Operationen in den Folgemonaten verzeichnet werden. Im Jahrestrend zeigen sich somit leicht rückläufige Zahlen. Ob dieser Trend auf eine erhöhte Sterblichkeit durch verschobene Operationen und geänderte Therapieregimes zurückzuführen ist, lässt sich derzeit zumindest nicht ausschließen. Eine SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion ist auf jeden Fall mit einem komplikativen Verlauf assoziiert, insbesondere im perioperativen Verlauf und nach Transplantation. Diskussion Aufgrund des erhöhten Risikoprofils der genannten Patientengruppen besteht ein erhöhtes Risiko für einen schweren COVID-19-Verlauf. Dies muss bei der Abwägung von Therapiealternativen, der Schutzempfehlungen und der Priorisierung bei Impfungen in Betracht gezogen werden.
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Affiliation(s)
- K Hillebrandt
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - N Nevermann
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - B Globke
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - S Moosburner
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Schmelzle
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Nevermann N, Wiering L, Wu H, Moroder P, Brandl A, Globke B, Krenzien F, Raschzok N, Schöning W, Lurje G, Öllinger R, Schmelzle M, Pratschke J, Ritschl PV. Transplantation programs facing lack of empirical evidence on SARS-CoV-2 vaccination: A society recommendation consensus update. Transpl Infect Dis 2021; 23:e13696. [PMID: 34288294 PMCID: PMC8420432 DOI: 10.1111/tid.13696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Since phase III trials for the most prominent vaccines excluded immunocompromised or immunosuppressed patients, data on safety and efficacy of SARS-CoV-2 vaccines for recipients of solid organ transplantations are scarce. AIMS Our study offers a synthesis of expert opinions aligned with available data addressing key questions of the clinical management of SARS-CoV-2 vaccinations for transplant patients. METHOD An online research was performed retrieving available recommendations by national and international transplantation organizations and state institutions on SARS-CoV2 vaccination management for transplant recipients. RESULTS Eleven key statements were identified from recommendations by 18 national and international societies, and consensus for the individual statements was evaluated by means of the Society Recommendation Consensus score. The highest consensus level (SRC A) was found for prioritized access to vaccination for transplant patients despite anticipation of a weakened immune response. All currently authorized vaccines can be considered safe for transplant patients (SRC A). The handling of immunosuppressive medication, the timely management of vaccines, and other aspects were aligned with available expert opinions. CONCLUSION Expert consensus can be determined for crucial aspects of the implementation of SARS-CoV-2 vaccination programs. We hereby offer a tool for immediate decision-making until empirical data becomes available.
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Affiliation(s)
- Nora Nevermann
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leke Wiering
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Helen Wu
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Moroder
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Brandl
- Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Brigitta Globke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Viktor Ritschl
- Department of Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
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Kute VB, Ray DS, Yadav DK, Pathak V, Bhalla AK, Godara S, Kumar A, Guleria S, Khullar D, Thukral S, Mondal RRS, Jain M, Jha PK, Hegde U, Abraham M A, Dalal S, Patel H, Bahadur MM, Shingare A, Sharma A, Kumar Sharma R, Anandh U, Gulati S, Gumber M, Siddini V, Deshpande R, Kaswan K, Varyani U, Kakde S, Kenwar DB, Shankar Meshram H, Kher V. A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19. Transplantation 2021; 105:1423-1432. [PMID: 33724246 DOI: 10.1097/tp.0000000000003740] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. METHODS We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. RESULTS Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. CONCLUSIONS Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Deepak S Ray
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Dinesh Kumar Yadav
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Vivek Pathak
- Department of Nephrology, Kovai Medical Center and Hospital, Coimbatore, Tamil-Nadu, India
| | - Anil K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Suraj Godara
- Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil Kumar
- Department of Nephrology BGS Global Hospital, Bengaluru, Karnataka, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Dinesh Khullar
- Nephrology and Renal Transplant Medicine, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
| | - Sharmila Thukral
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rabi Ranjan Sow Mondal
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Manish Jain
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Pranaw Kumar Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abi Abraham M
- Nephrology and Renal Transplant Services, VPS Lakeshore Hospital, Kochi, India
| | - Sonal Dalal
- Department of Nephrology, Gujarat Kidney Foundation, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Madan M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashay Shingare
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Raj Kumar Sharma
- Nephrology and Kidney Transplant Medicine, Kidney & Urology Institute, Medanta, Lucknow, India
| | - Urmila Anandh
- Department of Nephrology, Yashoda Hospital, Secunderabad, India
| | - Sanjeev Gulati
- Nephrology and Kidney Transplant Fortis Group of Hospitals, New Delhi, India
| | - Manoj Gumber
- Department of Nephrology, Apollo Hospitals International Limited, Gandhi Nagar, Ahmedabad, Gujarat, India
| | | | - Rushi Deshpande
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Kamal Kaswan
- Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, India
| | - Umesh Varyani
- Department of Nephrology Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Deepesh B Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
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43
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Kidney Transplantation in COVID Pandemic-A Review of Guidelines. J Clin Med 2021; 10:jcm10132877. [PMID: 34209504 PMCID: PMC8268775 DOI: 10.3390/jcm10132877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 12/17/2022] Open
Abstract
The paper describes problems with the transplantation process during the COVID-19 pandemic. Transplantation procedures and programs have been impacted by COVID-19. The number of transplants has fallen noticeably. The first part of the paper points out changes in service organization, in particular donor and recipient pre-transplant and peri-transplant management. If the patients during pre-transplant evaluation need to attend face-to-face appointments, such as blood testing or other investigations, the risk of contracting or spreading COVID-19 should be minimized. “Clear green areas”, which are COVID-19-free pathways, are highly recommended in hospitals during transplant procedures. Diagnostic procedures concerning donors, including CT scans and coronavirus testing (nasopharyngeal swab), are necessary before transplant surgery. COVID-19 symptoms and risks of the transplant population are described. Detailed guidelines from transplant societies concerning changes in immunosuppression in infected recipients are discussed. Management of infected or suspected medical staff is mentioned. The paper ends with guidelines concerning vaccination against COVID-19 in transplant recipients.
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44
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Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus. J Clin Med 2021; 10:jcm10132769. [PMID: 34202563 PMCID: PMC8269029 DOI: 10.3390/jcm10132769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/16/2023] Open
Abstract
The COVID-19 pandemic challenges international and national healthcare systems. In the field of thoracic surgery, procedures may be deferred due to mandatory constraints of the access to diagnostics, staff and follow-up facilities. There is a lack of prospective data on the management of benign and malignant thoracic conditions in the pandemic. Therefore, we derived recommendations from 14 thoracic societies to address key questions on the topic of COVID-19 in the field of thoracic surgery. Respective recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found to temporarily suspend non-critical elective procedures or procedures for benign conditions and to prioritize patients with symptomatic or advanced cancer. Prior to hospitalization, patients should be screened for respiratory symptoms indicating possible COVID-19 infection and most societies recommended to screen all patients for COVID-19 prior to admission. There was a weak consensus on the usage of serology tests and CT scans for COVID-19 diagnostics. Nearly all societies suggested to postpone elective procedures in patients with suspected or confirmed COVID-19 and recommended constant reevaluation of these patients. Additionally, we summarized recommendations focusing on precautions in the theater and the management of chest drains. This study provides a novel approach to informed guidance for thoracic surgeons during the COVID-19 pandemic in the absence of scientific evidence-based data.
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45
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Xu J, Han M, Huang C, Liao Y, Wang D, Zhu X, Wang C, Huang J, Guo Z, Chen G, He X. Single-center experience of organ transplant practice during the COVID-19 epidemic. Transpl Int 2021; 34:1812-1823. [PMID: 34152648 PMCID: PMC8420326 DOI: 10.1111/tri.13955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022]
Abstract
In order to safely carry out organ donation transplants during the outbreak of coronavirus disease 2019 (COVID-19), we have formulated strict procedures in place for organ donation and transplantation. We retrospectively analyzed our transplantation work from January 20 to May 5, 2020, to discuss whether organ transplantation can be carried out safely during the epidemic period. From January 20 to May 5, 43 cases of donation were carried out in our hospital, and the utilization rate of liver, kidney, heart, lung, and pancreas donations was more than 90%. Forty-one cases of liver transplantation and 84 cases of kidney transplantation were performed. No graft loss or recipient death occurred within one month after kidney transplantation, and one patient (2.4%) died after liver transplantation. There was no significant difference in the length of hospital stay compared with that during the same period in the previous three years. More importantly, COVID-19 infection did not occur among healthcare providers, donors, patients, or their accompanying families in our center. Under the premise of correct protection, it is safe and feasible to carry out organ transplantation during the epidemic period. Our experience during the outbreak might provide a clinical reference for countries facing COVID-19 worldwide.
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Affiliation(s)
- Jinghong Xu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Ming Han
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Changjun Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yuan Liao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jiefu Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Guodong Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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46
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Balsara KR, Rahaman Z, Sandhaus E, Hoffman J, Zalawadiya S, McMaster W, Lindenfeld J, Wigger M, Absi T, Brinkley DM, Menachem J, Punnoose L, Sacks S, Schlendorf K, Shah AS. Prioritizing heart transplantation during the COVID-19 pandemic. J Card Surg 2021; 36:3217-3221. [PMID: 34137079 PMCID: PMC8447084 DOI: 10.1111/jocs.15731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/20/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) has significantly impacted the healthcare landscape in the United States in a variety of ways including a nation‐wide reduction in operative volume. The impact of COVID‐19 on the availability of donor organs and the impact on solid organ transplant remains unclear. We examine the impact of COVID‐19 on a single, large‐volume heart transplant program. Methods A retrospective chart review was performed examining all adult heart transplants performed at a single institution between March 2020 and June 2020. This was compared to the same time frame in 2019. We examined incidence of primary graft dysfunction, continuous renal replacement therapy (CRRT) and 30‐day survival. Results From March to June 2020, 43 orthotopic heart transplants were performed compared to 31 performed during 2019. Donor and recipient demographics demonstrated no differences. There was no difference in 30‐day survival. There was a statistically significant difference in incidence of postoperative CRRT (9/31 vs. 3/43; p = .01). There was a statistically significant difference in race (23 W/8B/1AA vs. 30 W/13B; p = .029). Conclusion We demonstrate that a single, large‐volume transplant program was able to grow volume with little difference in donor variables and clinical outcomes following transplant. While multiple reasons are possible, most likely the reduction of volume at other programs allowed us to utilize organs to which we would not have previously had access. More significantly, our growth in volume was coupled with no instances of COVID‐19 infection or transmission amongst patients or staff due to an aggressive testing and surveillance program.
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Affiliation(s)
- Keki R Balsara
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zakiur Rahaman
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily Sandhaus
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan Hoffman
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandip Zalawadiya
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joann Lindenfeld
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Wigger
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tarek Absi
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas M Brinkley
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Menachem
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lynn Punnoose
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzie Sacks
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly Schlendorf
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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47
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Kulkarni AV, Parthasarathy K, Kumar P, Sharma M, Reddy R, Chaitanya Akkaraju Venkata K, Gupta R, Gupta A, Swaroop S, Giri Vishwanathan P, Senapathy G, Menon PB, Reddy ND, Padaki NR. Early liver transplantation after COVID-19 infection: The first report. Am J Transplant 2021; 21:2279-2284. [PMID: 33508881 PMCID: PMC8013377 DOI: 10.1111/ajt.16509] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/25/2023]
Abstract
COVID-19 (coronavirus disease 2019) has impacted solid organ transplantation (SOT) in many ways. Transplant centers have initiated SOT despite the COVID-19 pandemic. Although it is suggested to wait for 4 weeks after COVID-19 infection, there are no data to support or refute the timing of liver transplant after COVID-19 infection. Here we describe the course and outcomes of COVID-19-infected candidates and healthy living liver donors who underwent transplantation. A total of 38 candidates and 33 potential living donors were evaluated from May 20, 2020 until October 30, 2020. Ten candidates and five donors were reverse transcriptase-polymerase chain reaction (RT-PCR) positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pretransplant. Four candidates succumbed preoperatively. Given the worsening of liver disease, four candidates underwent liver transplant after 2 weeks due to the worsening of liver disease and the other two candidates after 4 weeks. Only one recipient died due to sepsis posttransplant. Three donors underwent successful liver donation surgery after 4 weeks of COVID-19 infection without any postoperative complications, and the other two were delisted (as the candidates expired). This report is the first to demonstrate the feasibility of elective liver transplant early after COVID-19 infection.
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Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Kumarswamy Parthasarathy
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pramod Kumar
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Raghuram Reddy
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rajesh Gupta
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Anand Gupta
- Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shakti Swaroop
- Department of Anaesthesia, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Gayathri Senapathy
- Department of Radiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Palat B. Menon
- Department of Liver Transplantation and Hepatobiliary Surgery, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D. Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nagaraja R. Padaki
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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48
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Lentine KL, Mannon RB, Josephson MA. Practicing With Uncertainty: Kidney Transplantation During the COVID-19 Pandemic. Am J Kidney Dis 2021; 77:777-785. [PMID: 33388404 PMCID: PMC7946342 DOI: 10.1053/j.ajkd.2020.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic required transplant nephrologists, surgeons, and care teams to make decisions about the full spectrum of transplant program operations and clinical practices in the absence of experience or data. Initially, across the country, there was a reduction in kidney transplant procedures and a striking pause in the conduct of living donation and living-donor transplant surgeries. Aspects of candidate evaluation and follow-up rapidly converted to telehealth. Months into the pandemic, much has been learned from experiences worldwide, yet many questions remain. In this Perspective, we reflect on some of the practice decisions made by the transplant community in the initial response to the pandemic and consider lessons learned, including those related to the risks, benefits, and logistical considerations of proceeding with versus delaying deceased-donor transplantation, living donation, and living-donor transplantation during the pandemic. We review the evolution of therapeutic strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their use in transplant recipients, current consensus related to immunosuppression management in infected transplant recipients, and emerging information on vaccination against SARS-CoV-2. We share our thoughts on research priorities, discuss the areas in which we are still practicing with uncertainty, and look ahead to the next phase of the pandemic response.
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Affiliation(s)
- Krista L Lentine
- Division of Nephrology, Department of Medicine, Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center and Medical Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE
| | - Michelle A Josephson
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL.
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49
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Raveh Y, Simkins J, Vianna R, Tekin A, Nicolau-Raducu R. A Less Restrictive Policy for Liver Transplantation in Coronavirus Disease 2019 Positive Patients, Based Upon Cycle Threshold Values. Transplant Proc 2021; 53:1126-1131. [PMID: 33610305 PMCID: PMC7816591 DOI: 10.1016/j.transproceed.2021.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 drastically impacted solid organ transplantation. Lacking scientific evidence, a very stringent but safer policy was imposed on liver transplantation (LT) early in the pandemic. Restrictive transplant guidelines must be reevaluated and adjusted as data become available. Before LT, the prevailing policy requires a negative severe acute respiratory syndrome coronavirus 2 real-time polymerase chain reaction (RT-PCR) of donors and recipients. Unfortunately, prolonged viral RNA shedding frequently hinders transplantation. Recent data reveal that positive test results for viral genome are frequently due to noninfectious and prolonged convalescent shedding of viral genome. Moreover, studies demonstrated that the cycle threshold of quantitative RT-PCR could be leveraged to inform clinical transplant decision-making. We present an evidence-adjusted and significantly less restrictive policy for LT, where risk tolerance is tiered to recipient acuity. In addition, we delineate the pretransplant clinical decision-making, intra- and postoperative management, and early outcome of 2 recipients of a liver graft performed while their RT-PCR of airway swabs remained positive. Convalescent positive RT-PCR results are common in the transplant arena, and the proposed policy permits reasonably safe LT in many circumstances.
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Affiliation(s)
- Yehuda Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida.
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida
| | - Rodrigo Vianna
- Department of Surgery, Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Akin Tekin
- Department of Surgery, Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Ramona Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
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50
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Coll E, Fernández-Ruiz M, Sánchez-Álvarez JE, Martínez-Fernández JR, Crespo M, Gayoso J, Bada-Bosch T, Oppenheimer F, Moreso F, López-Oliva MO, Melilli E, Rodríguez-Ferrero ML, Bravo C, Burgos E, Facundo C, Lorenzo I, Yañez Í, Galeano C, Roca A, Cabello M, Gómez-Bueno M, García-Cosío M, Graus J, Lladó L, de Pablo A, Loinaz C, Aguado B, Hernández D, Domínguez-Gil B, the Spanish Group for the Study of COVID-19 in Transplant Recipients. COVID-19 in transplant recipients: The Spanish experience. Am J Transplant 2021; 21:1825-1837. [PMID: 33098200 PMCID: PMC9906239 DOI: 10.1111/ajt.16369] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).
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Affiliation(s)
- Elisabeth Coll
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
| | - J. Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
| | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Jorge Gayoso
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francesc Moreso
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | | | - Edoardo Melilli
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Carlos Bravo
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - Elena Burgos
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
| | - Inmaculada Lorenzo
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Íñigo Yañez
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Cristina Galeano
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Roca
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel Gómez-Bueno
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - MaDolores García-Cosío
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Javier Graus
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Alicia de Pablo
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmelo Loinaz
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Aguado
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
| | - Domingo Hernández
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
| | - Beatriz Domínguez-Gil
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - the Spanish Group for the Study of COVID-19 in Transplant Recipients
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Nephrology, Hospital Clinic, Barcelona, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department oof Nephrology, Hospital Universitario La Paz, Madrid, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
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