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Shumakov DV, Zybin DI, Zulkarnaev AB, Dontsov VV, Agafonov EG, Popov MA. Transplantation of solid organs during the pandemic of a new coronavirus infection. TRANSPLANTOLOGIYA. THE RUSSIAN JOURNAL OF TRANSPLANTATION 2023; 15:376-389. [DOI: 10.23873/2074-0506-2023-15-3-376-389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The end-stage stage of chronic diseases of solid organs is rather significant in the structure of morbidity and mortality among patients worldwide. To date, there are more than six million patients in this status worldwide. Heart, liver and kidney transplantation is the gold standard of treatment for these patients. The number of transplants is growing every year.At the end of 2019, the world faced a new type of viral infection – SARS-CoV-2 – a highly contagious systemic respiratory disease transmitted by airborne droplets, which in three months led to a pandemic and killed hundreds of thousands of people. The pandemic has made adjustments to the structure of planned medical care. The number of planned operations has decreased significantly, and the number of the infection-associated complications has increased.Patients with end-stage chronic diseases initially have weakened immunity and represent the category most susceptible to the infection. At the moment, the question of patient management tactics remains open. There is no consensus on the patient management tactics before surgery and in the posttransplantation period for patients at the end-stage chronic disease of different organs. This topic requires further study and the development of treatment algorithms for such patients.
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Affiliation(s)
- D. V. Shumakov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - D. I. Zybin
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - A. B. Zulkarnaev
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - V. V. Dontsov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - E. G. Agafonov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
| | - M. A. Popov
- Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
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2
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Global Effects of SARS-CoV-2 Era on Kidney Transplantation Activities: Analysis of WHO Data. Transplant Proc 2021; 54:1417-1423. [PMID: 34986975 PMCID: PMC8720483 DOI: 10.1016/j.transproceed.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 12/15/2022]
Abstract
Background Uncertainty raises questions in kidney transplant during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic regarding the recipient, the donor, and health care professionals. The pandemic not only has disrupted kidney transplanted patients but also has influenced transplant systems, donation chains, and timely and safe transplant surgeries. In the present study, we aimed to explore the global effects of the SARS-CoV-2 pandemic on kidney transplant. Methods We collected transplantation statistics and SARS-CoV-2 pandemic data from the World Health Organization website on June 15, 2021. Spearman correlation analysis was applied to assess the strength of a monotonic relationship among quantitative variables. We also demonstrated the clinical characteristics of our kidney recipients with SARS-CoV-2 infection. Results Comparison of the mean of global kidney transplantation statistics between 2010 and 2019 with 2020 statistics showed a significant decrease in kidney transplant from living donors (P < .001). From the beginning of the pandemic to June 15, 2021, 1 of the 43 kidney transplant patients we treated in our clinic died of SARS-CoV-2 infection after discharge. Two of the patients we transplanted and saw in follow-up before the pandemic died of SARS-CoV-2 infection. Conclusion While the overall kidney transplant numbers have increased in the year to date, kidney transplants decreased drastically at the onset of the pandemic.
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Alfishawy M, Nso N, Nassar M, Ariyaratnam J, Bhuiyan S, Siddiqui RS, Li M, Chung H, Al Balakosy A, Alqassieh A, Fülöp T, Rizzo V, Daoud A, Soliman KM. Liver transplantation during global COVID-19 pandemic. World J Clin Cases 2021; 9:6608-6623. [PMID: 34447809 PMCID: PMC8362541 DOI: 10.12998/wjcc.v9.i23.6608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally. Liver transplantation (LT) has faced an unequivocal challenge during this unprecedented time. This targeted review aims to cover most of the clinical issues, challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.
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Affiliation(s)
- Mostafa Alfishawy
- Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo 0000, Egypt
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Jonathan Ariyaratnam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Sakil Bhuiyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Raheel S Siddiqui
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Matthew Li
- Clinical pharmacy department, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Howard Chung
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Amira Al Balakosy
- Tropical Medicine Department, Ain Shams University, Cairo 11517, Egypt
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Tibor Fülöp
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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Shafiekhani M, Kazemi K, Bahador A, Imanieh MH, Karimzadeh P. Pediatric liver and kidney transplantation in the era of COVID-19: a follow-up study from a tertiary referral center in Iran. BMC Surg 2021; 21:240. [PMID: 33975594 PMCID: PMC8112472 DOI: 10.1186/s12893-021-01226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to evaluate the impact of COVID-19 pandemic on pediatric transplant outcomes and determine whether to continue pediatric transplant activity or not, and how policies intended our center has been effective in preventing COVID-19 among organ transplant recipients. METHODS We conducted a single-center, retrospective, cohort study of hospitalized pediatrics after organ transplantation at Shiraz transplant center since March to August 2020. All liver and kidney transplanted children were included the study and their laboratory and clinical related COVID-19 characteristics were followed up till 3 months after transplantation during hospitalization period and then weekly by the transplant committee. RESULTS Fifty-one patients underwent transplantation including 11 kidney and 40 liver recipients. The mean age of the pediatric cases was 6.72 ± 5.47 years. A total of 11 patients died due to post-transplant complications, while none of the patients presented any sign or symptoms in favor of COVID-19 in the hospital course after transplantation. Six transplants including 2 kidney and 4 liver were canceled when positive PCR tests were detected in their donors before the surgery. In the 3 months of follow up, two patients presented with symptoms including high grade fever, malaise, rhinorrhea, and GI symptoms. Both patients had two negative PCR, and no radiologic or laboratory results regarding COVID-19 were also detected. One had positive influenza PCR, while the second one had a positive serologic test for EBV; CT, computed tomography CONCLUSION: Transplant programs could continue their activities during the COVID-19 pandemic with specific case selection, accurate screening methods and following protective protocols.
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Affiliation(s)
- Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Bahador
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Department of Pediatrics Gastroenterology and Hepatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Karimzadeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kong D, Li M, Gong W. SARS-Cov-2 infection in transplant-related biology: Where do we stand? Ann Transplant 2020; 25:e924768. [PMID: 33372171 PMCID: PMC7777149 DOI: 10.12659/aot.924768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, the novel coronavirus (SARS-CoV-2) emerged in Wuhan and rapidly spread throughout the world. There are nearly 3 951 905 confirmed cases of novel coronary pneumonia and more than 275 067 deaths worldwide, [JHU data-09/05/2020, https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6]. A great number of patients contracted SARS-Cov-2 pneumonia (COVID-19). SARS-CoV-2 invades human target cells through receptor angiotensin-converting enzyme II (ACE2), which are expressed in the lung, kidney, and ileum and mediate inflammatory responses and immune activities. High plasma levels of proinflammatory cytokines were detected in the infected patients. These factors may predispose transplant patients to high risk of poor outcomes. Therefore, transplant patients might be affected by this coronavirus infection and protection of allografts should receive special attention during this outbreak. In the present study we attempt to delineate the transplant-related biology of SARS-CoV-2 infection.
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Affiliation(s)
- Deqiang Kong
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Mingming Li
- Physical Examination Center, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Weihua Gong
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Palleschi A, Rosso L, Morlacchi LC, Del Gobbo A, Ramondetta M, Gori A, Blasi F, Nosotti M. Early acute rejection after lung transplantation mimicking viral pneumonia in the middle of COVID-19 pandemic: A case report. Int J Surg Case Rep 2020; 77:80-85. [PMID: 33157338 PMCID: PMC7598439 DOI: 10.1016/j.ijscr.2020.10.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
Abstract
An atypical clinical presentation of early antibody-mediated rejection in COVID era. The radiological features mimicked SARS-CoV2 pneumonia, but tests were negative. This is the first report of lung transplantation in the COVID era in Europe. Decide whether to keep lung transplantation programmes open in a COVID Hospital. Introduction In addition to morbidity and mortality rate per se, COVID-19 outbreak leads to potential ‘side effects’, which are difficult to evaluate and predict. Lung transplantation is a consolidated treatment for end-stage chronic lung disease requiring significantly demanding management. Deciding whether to keep transplant programmes open during an epidemic of this size is not easy, as immunosuppressed subjects face the risk of infection and related mortality. Additionally, there is a chance for the patient’s standard care process to be compromised. Presentation of case We report the case of a patient undergoing bilateral lung transplantation during the explosion of COVID-19 epidemic in Lombardy; he died from definite early acute antibody-mediated rejection, clinically (persistent high fever, unresponsive to treatment) and radiologically mimicking viral pneumonia but persistently negative for SARS-CoV-2. Discussion The diagnosis was difficult given this atypical presentation, confounded by global scenario. Grafts were procured from a donation after circulatory death donor in an uncontrolled setting and a donor-recipient transmission was possible. Our institute became a COVID-Hospital right during the first post-transplantation days. Radiological imaging had the same features of SARS-CoV-2 pneumonia. Conclusions This is the first report of lung transplantation of the COVID-19 era in Europe. Our extremely fragile patient was COVID-19 free up to the end. Donor-recipient transmission is conceivable, but the risk should be assessed with respect to waiting list mortality. Ultimately, treating COVID-19 patients can be a resource-consuming activity but we decided to keep our centre open.
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Key Words
- AMR, antibody-mediated rejection
- Acute antibody-mediated rejection
- BAL, bronchoalveolar lavage
- COVID-19
- CT, computed tomography
- Case report
- DCD, donation after circulatory death
- DSA, donor-specific antibodies
- Donation after circulatory death donor
- FiO2, fraction of inspired oxygen
- ICU, intensive care unit
- Lung transplantation
- NIV, non-invasive ventilation
- PCR, polymerase chain reaction
- POD, post-operative day
- PaO2, partial arterial oxygen pressure
- SARS-CoV-2
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Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy; University of Milan, Italy.
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy; University of Milan, Italy
| | - Letizia Corinna Morlacchi
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy
| | - Alessandro Del Gobbo
- Pathology Unit, Center - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy
| | - Miriam Ramondetta
- North Italy Transplant Program (NITp), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy
| | - Andrea Gori
- University of Milan, Italy; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy
| | - Francesco Blasi
- University of Milan, Italy; Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy; University of Milan, Italy
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7
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Jaffe A, Schilsky ML, Deshpande R, Batra R. Liver Transplantation in the Time of COVID19: Barriers and Ethical Considerations for Management and Next Steps. Hepatol Commun 2020; 4:1242-1256. [PMID: 32838103 PMCID: PMC7361607 DOI: 10.1002/hep4.1568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
The recent outbreak of the novel virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes the corona virus disease of 2019 (COVID19), has spread globally and affects millions of people. This pandemic has taxed our health care system and disrupted normal operations, even life-saving procedures, such as liver transplants. During these unprecedented times, providers and patients are imperiled and resources for diagnosis and care may be limited. Continuing to perform resource-intense advanced procedures is challenging, as is caring for patients with end-stage liver disease or patients with urgent needs for liver tumor control. Liver transplantation, in particular, requires critical resources, like blood products and critical care beds, which are fairly limited in the COVID19 pandemic. The potential of COVID19 infections in posttransplant recipients on immunosuppression and staff contacts further adds to the complexity. Therefore, transplant programs must reevaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end-stage liver disease during the COVID19 pandemic.
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Affiliation(s)
- Ariel Jaffe
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
| | - Michael L. Schilsky
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
- Yale New Haven Transplantation CenterYale School of MedicineNew HavenCT
| | | | - Ramesh Batra
- Division of Digestive Diseases, Department of MedicineYale School of MedicineNew HavenCT
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8
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Spoletini G, Bianco G, Graceffa D, Lai Q. Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger. BMC Gastroenterol 2020; 20:259. [PMID: 32762651 PMCID: PMC7407436 DOI: 10.1186/s12876-020-01401-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
The global health crisis due to the fast spread of coronavirus disease (COVID-19) has caused major disruption in all aspects of healthcare. Transplantation is one of the most affected sectors, as it relies on a variety of services that have been drastically occupied to treat patients affected by COVID-19. With this report from two transplant centers in Italy, we aim to reflect on resource organization, organ allocation, virus testing and transplant service provision during the course of the pandemic and to provide actionable information highlighting advantages and drawbacks.To what extent can we preserve the noble purpose of transplantation in times of increased danger? Strategies to minimize risk exposure to the transplant population and health- workers include systematic virus screening, protection devices, social distancing and reduction of patients visits to the transplant center. While resources for the transplant activity are inevitably reduced, new dilemmas arise to the transplant community: further optimization of time constraints during organ retrievals and implantation, less organs and blood products donated, limited space in the intensive care unit and the duty to maintain safety and outcomes.
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Affiliation(s)
- Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
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9
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Maggi U, De Carlis L, Yiu D, Colledan M, Regalia E, Rossi G, Angrisani M, Consonni D, Fornoni G, Piccolo G, DeFeo TM. The impact of the COVID-19 outbreak on liver transplantation programs in Northern Italy. Am J Transplant 2020; 20:1840-1848. [PMID: 32330351 PMCID: PMC7264498 DOI: 10.1111/ajt.15948] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
In January 2020, Novel Coronavirus Disease 2019 (COVID-19) resulted in a global pandemic, creating uncertainty toward the management of liver transplantation (LT) programs. Lombardy has been the most affected region in Italy: the current mortality rate of COVID-19 patients is 18.3% (10 022 deaths; April 10th) with hospitals in Lombardy having to expand the total number of ICU beds from 724 to 1381 to accommodate infected patients. There has been a drastic decrease in liver donors. From February 23rd until April 10th, 17 LTs were performed in Lombardy. Mean donor age was 49 years (range 18-74) whereas mean recipient age was 55 (13-69); mean MELD score was 12 (6-24). All donors underwent screening for SARS-CoV-2 prior to LT. Two patients tested positive after LT, and one patient died for COVID on POD 30. Sixteen patients are alive after an average of 30 days post-LT (range 3-46). 10 patients have been discharged. This study has found no specific reason concerning the safety of recipients, to stop LT programs. Several key lessons from our experience are reported. However, due to the complex circumstances which surround the viral outbreak, the cessation or a reduction in LT activity is a pragmatic requirement.
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Affiliation(s)
- Umberto Maggi
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy,Correspondence Umberto Maggi
| | - Luciano De Carlis
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniel Yiu
- Emergency Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Michele Colledan
- Division of Liver and Small Bowel Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Enrico Regalia
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Giorgio Rossi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marco Angrisani
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Fornoni
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - T. Maria DeFeo
- Transplant Coordination Reference Center – North Italy Transplant program (CRR/NITp), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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10
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Liu H, He X, Wang Y, Zhou S, Zhang D, Zhu J, He Q, Zhu Z, Li G, Sun L, Wang J, Cheng G, Liu Z, Lau G. Management of COVID-19 in patients after liver transplantation: Beijing working party for liver transplantation. Hepatol Int 2020; 14:432-436. [PMID: 32277387 PMCID: PMC7146012 DOI: 10.1007/s12072-020-10043-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Abstract
Annually, around 850 liver transplantation is performed in Beijing, China. Recently, the new coronavirus pneumonia (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) has affected nearly 200 countries worldwide. 2019-nCov can cause severe lung disease, multiple-organ damage, and significant mortalities. Liver transplant recipients, because of long-term oral immunosuppressant effects, may be more susceptible to 2019-nCoV infection and have a worse prognosis than the general population. It is urgent to set up guidelines for the prevention, diagnosis, and treatment of COVID-19 in liver transplant recipients. In this article, we reviewed the clinical aspects of 2019-nCoV infection, characteristics of liver transplant recipients, immunosuppressant usage, and potential drug interactions to provide recommendations to clinical staff managing liver transplant recipients during the COVID-19 epidemic.
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Affiliation(s)
- Hongling Liu
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China
| | - Xi He
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China
| | - Yudong Wang
- Humanity and Health Medical Group, Humanity and Health Clinical Trial Center, Unit 2101, 21F, No. 9 Queen's Road Central, Hong Kong, SAR, China
| | - Shuangnan Zhou
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China
| | - Dali Zhang
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China
| | - Jiye Zhu
- Department of Surgery, People's Hospital, Beijing Medical University, Beijing, 100044, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhijun Zhu
- Clinical Center for Pediatric Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Guangming Li
- Department of General Surgery and Liver Transplant Center, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Libo Sun
- Department of General Surgery and Liver Transplant Center, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Jianli Wang
- Department of Liver Transplantation, The Third Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Gregory Cheng
- Humanity and Health Medical Group, Humanity and Health Clinical Trial Center, Unit 2101, 21F, No. 9 Queen's Road Central, Hong Kong, SAR, China
| | - Zhenwen Liu
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China.
| | - George Lau
- Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital, 100 West 4th Ring Middle Road, Beijing, 100039, China.
- Humanity and Health Medical Group, Humanity and Health Clinical Trial Center, Unit 2101, 21F, No. 9 Queen's Road Central, Hong Kong, SAR, China.
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11
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Esagian SM, Ziogas IA, Giannis D, Hayat MH, Elias N, Tsoulfas G. Challenges in Abdominal Organ Transplantation During the COVID-19 Pandemic. Front Med (Lausanne) 2020; 7:287. [PMID: 32582741 PMCID: PMC7287204 DOI: 10.3389/fmed.2020.00287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) outbreak has rapidly evolved into a global pandemic, abdominal organ transplantation programs are currently facing multiple challenges. Transplant candidates and recipients are considered high-risk populations for severe disease and death due to COVID-19 as a result of their numerous underlying comorbidities, advanced age and impaired immune function. Emerging reports of atypical and delayed clinical presentations in these patients generate further concerns for widespread disease transmission to medical personnel and the community. The striking similarities between COVID-19 and other outbreaks that took place over the past two decades, like Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, highlight the severity of the situation and dictate that extra measures should be taken by the transplant programs to avoid adverse outcomes. Transplant organizations are currently calling for strict screening and isolation protocols to be established in all transplant programs, for both organ donors and recipients. As the situation escalates, more radical measures might be necessary, including a temporary hold on non-urgent transplantations, resulting in serious ethical dilemmas between the survival of these patients and the safety of the community. Further data about these special populations could result in more individualized guidelines for abdominal organ transplantation in the era of COVID-19.
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Affiliation(s)
| | - Ioannis A. Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dimitrios Giannis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Institute of Health Innovations and Outcomes Research, The Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Muhammad H. Hayat
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nahel Elias
- Department of Surgery, Transplantation Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Georgios Tsoulfas
- First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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D'Antiga L. Coronaviruses and Immunosuppressed Patients: The Facts During the Third Epidemic. Liver Transpl 2020; 26:832-834. [PMID: 32196933 DOI: 10.1002/lt.25756] [Citation(s) in RCA: 486] [Impact Index Per Article: 97.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology, and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
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13
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Woolley AE, Mehra MR. Dilemma of organ donation in transplantation and the COVID-19 pandemic. J Heart Lung Transplant 2020; 39:410-411. [PMID: 32362391 PMCID: PMC7270729 DOI: 10.1016/j.healun.2020.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ann E Woolley
- Department of Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mandeep R Mehra
- Department of Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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14
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Abstract
A wide range of viruses affect the respiratory tract of transplant recipients, including adenovirus, influenza, human metapneumovirus, parainfluenza virus, respiratory syncytial virus (RSV) and rhinovirus. Prospective studies using contemporary diagnostic techniques have recently improved our understanding of the epidemiology and importance of these respiratory viruses among transplant recipients. From these studies, rhinovirus, in particular, has been shown to be one of the most common causes of infection in stem cell and lung transplant recipients. In addition to epidemiological data, recent studies have also advanced our understanding of management of influenza, adenovirus, and RSV infections among transplant recipients.
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Affiliation(s)
- Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Chen TJ, Lin MH, Chou LF, Hwang SJ. Hospice utilization during the SARS outbreak in Taiwan. BMC Health Serv Res 2006; 6:94. [PMID: 16889656 PMCID: PMC1559606 DOI: 10.1186/1472-6963-6-94] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 08/04/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan. METHODS The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic. RESULTS Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ. CONCLUSION Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.
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Affiliation(s)
- Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
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16
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Abstract
Despite the progress made in graft and patient survival in recent years, infectious complications remain a major source of morbidity and mortality in pediatric solid organ transplant recipients. The risk of infection after transplant is determined by the interaction of several factors, including age, type of organ transplanted, type and intensity of immunosuppression, environmental exposures, and the consequences of invasive procedures. Compared with adult transplant recipients, children are at higher risk of developing primary infection with various organisms after transplantation, as they often lack previous immunity from natural exposure to many microbes and often have not completed their primary immunization series at the time of transplantation. This article provides an overview of the risk factors, timing, and types of infectious complications associated with organ transplantation in children.
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Affiliation(s)
- Monica Fonseca-Aten
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marian G. Michaels
- Division of Allergy, Immunology and Infectious Diseases, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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18
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Abstract
PURPOSE OF REVIEW Transplant patients are uniquely predisposed to emerging infections for a number of reasons. Two outbreaks, West Nile virus and severe acute respiratory syndrome, have recently provided important lessons on how transplant patients are affected, and how transplant programmes must adapt and evolve in the face of emerging infections. An update of emerging infections in transplant patients, using West Nile virus and severe acute respiratory syndrome as specific examples, is summarized here. RECENT FINDINGS Exogenous immunosuppression, specific allograft factors, and extensive contact with the healthcare system all predispose transplant patients to emerging infections. Transplant patients may acquire West Nile virus through blood transfusion, donor transmission, or community exposure. Seroprevalence data in transplant populations suggest the risk of severe neurological disease is several fold higher in transplant recipients who acquire West Nile virus compared with immunocompetent individuals. Prevention strategies are critical in this population. These include nucleic acid testing of blood products and potentially also screening organ donors in a similar manner. During the outbreak of severe acute respiratory syndrome, transplant patients with severe and rapidly progressive disease were reported. Higher viral burdens appeared to be present in transplant patients and may have implications for the increased infectivity of these patients. Transplant programmes in severe acute respiratory syndrome areas were also adversely affected because of donor concerns, recipient issues and resource problems. SUMMARY Transplant patients are uniquely predisposed to emerging infections. Lessons learned from West Nile virus and severe acute respiratory syndrome in transplantation should be applicable to future outbreaks of other emerging infectious diseases.
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Affiliation(s)
- Deepali Kumar
- Transplant Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
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