Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: A By-proxy Society Recommendation Consensus approach

Paul V Ritschl, Nora Nevermann, Leke Wiering, Helen H Wu, Philipp Moroder, Andreas Brandl, Karl Hillebrandt, Frank Tacke, Frank Friedersdorff, Thorsten Schlomm, Wenzel Schöning, Robert Öllinger, Moritz Schmelzle, Johann Pratschke, Paul V Ritschl, Nora Nevermann, Leke Wiering, Helen H Wu, Philipp Moroder, Andreas Brandl, Karl Hillebrandt, Frank Tacke, Frank Friedersdorff, Thorsten Schlomm, Wenzel Schöning, Robert Öllinger, Moritz Schmelzle, Johann Pratschke

Abstract

The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has a drastic impact on national health care systems. Given the overwhelming demand on facility capacity, the impact on all health care sectors has to be addressed. Solid organ transplantation represents a field with a high demand on staff, intensive care units, and follow-up facilities. The great therapeutic value of organ transplantation has to be weighed against mandatory constraints of health care capacities. In addition, the management of immunosuppressed recipients has to be reassessed during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In addressing these crucial questions, transplant physicians are facing a total lack of scientific evidence. Therefore, the aim of this study was to offer an approach of consensus-based guidance, derived from individual information of 22 transplant societies. Key recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found for temporarily suspending nonurgent transplant procedures and living donation programs. Systematic polymerase chain reaction-based testing of donors and recipients was broadly recommended. Additionally, more specific aspects (eg, screening of surgical explant teams and restricted use of marginal donor organs) were included in our analysis. This study offers a novel approach to informed guidance for health care management when a priori no scientific evidence is available.

Keywords: clinical research/practice; guidelines; health services and outcomes research; infection and infectious agents-viral; infectious disease; organ acceptance; organ allocation; organ procurement; organ procurement and allocation; organ transplantation in general.

© 2020 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

FIGURE 1
FIGURE 1
Consensus chart of the individual transplant societies. Relevant key statements were deduced and formulated on the basis of information found on the individual transplantation society webpages. Categories were defined as (A) do support (green), (B) do not support (red), (C) leave the answer open/case-by-case decision (orange), or (D) do not comment (white). On the right-hand side, the sum of supporting society recommendations was subtracted by dissenting votes and a final score was calculated. The final score was converted into a society recommendation consensus (SRC; “strong recommendation” = A, if more than 9 societies support the statement, >50%; “medium recommendation” = B, if 5-9 societies support the statement, >25%; “low recommendation” = C, if 1-4 societies support the statement, wileyonlinelibrary.com]

References

    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the chinese center for disease control and prevention. JAMA. 2020;323(13):1239.
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062.
    1. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal [published online ahead of print 2020]. J Heart Lung Transplant. 10.1016/j.healun.2020.03.012
    1. Guillen E, Pineiro GJ, Revuelta I, et al. Case report of COVID-19 in a kidney transplant recipient: does immunosuppression alter the clinical presentation [published online ahead of print 2020]? Am J Transplant. 10.1111/ajt.15874
    1. Services CfMM. Adult elective surgery and procedures recommendations. . Accessed March 28, 2020.
    1. Kumar D, Tellier R, Draker R, Levy G, Humar A. Severe Acute Respiratory Syndrome (SARS) in a liver transplant recipient and guidelines for donor SARS screening. Am J Transplant. 2003;3(8):977–981.
    1. Organization WH. . Accessed March 28, 2020.
    1. Prevention CoDCa. . Accessed March 28, 2020.
    1. Park JY, Kim MH, Bae EJ, et al. Comorbidities can predict mortality of kidney transplant recipients: comparison with the Charlson Comorbidity Index. Transplant Proc. 2018;50(4):1068–1073.
    1. D’Antiga L. Coronaviruses and immunosuppressed patients. The facts during the third epidemic [published online ahead of print 2020]. Liver Transpl. 10.1002/lt.25756
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
    1. Transplantation CSo. . Accessed March 27,2020.
    1. Professionals N-TOfT. . Accessed March 28, 2020.
    1. Luo S, Zhang X, Xu H. Don’t overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19) [published online ahead of print 2020]. Clin Gastroenterol Hepatol. 10.1016/j.cgh.2020.03.043
    1. Transplantation KSo. . Accessed March 28, 2020.
    1. Alhazzani W, Møller MH, Arabi YM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19) [published online ahead of print 2020]. Crit Care Med. 10.1007/s00134-020-06022-5
    1. Zhu L, Xu X, Ma KE, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression [published online ahead of print 2020]. Am J Transplant. 10.1111/ajt.15869
    1. Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Medicine. 2006;3(9):e343.
    1. (SEIMC) SSoT. . Accessed March 28, 2020.
    1. Transplantation ASo. . Accessed March 28, 2020.
    1. Ranney ML, Griffeth V, Jha AK. Critical supply shortages - the need for ventilators and personal protective equipment during the Covid-19 pandemic [published online ahead of print 2020]. N Engl J Med. 10.1056/NEJMp2006141
    1. Kumar D, Manuel O, Natori Y, et al. COVID-19: a global transplant perspective on successfully navigating a pandemic [published online ahead of print 2020]. Am J Transplant. 10.1111/ajt.15876
    1. Transplantation ISo. . Accessed March 28, 2020.
    1. Sofia GEi. . Accessed March 28, 2020.
    1. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens [published online ahead of print 2020]. JAMA. 10.1001/jama.2020.3786
    1. Service BNH. . Accessed March 28, 2020.
    1. Transplantation GSo. 2020. . Accessed June 4, 2020.
    1. Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;200432. 10.1148/radiol.2020200432.
    1. Chen W, Lan Y, Yuan X, et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microbes Infect. 2020;9(1):469–473.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
    1. Malinis M, Boucher HW, AST Infectious Diseases Community of Practice Screening of donor and candidate prior to solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548.

Source: PubMed

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